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Sildenafil prevents cardiovascular changes after bone marrow fat embolization in sheep


Krebs, Jörg; Ferguson, Stephen J; Nuss, Katja M; Leskosek, Boris; Hoerstrup, Simon P; Goss, Ben G; Aebli, Nikolaus (2007). Sildenafil prevents cardiovascular changes after bone marrow fat embolization in sheep. Anesthesiology, 107(1):75-81.

Abstract

BACKGROUND: Sudden, intraoperative cardiovascular deterioration as a result of pulmonary embolization of bone marrow fat is a potentially fatal complication during total hip and knee arthroplasty, intramedullary nailing, and spine surgery. Anesthetic management is challenging in the presence of increased right ventricular afterload due to pulmonary hypertension. Selective pulmonary vasodilation may be an appropriate prophylactic or therapeutic measure. The effect of sildenafil (phosphodiesterase inhibitor) on cardiovascular deterioration after bone marrow fat embolization was therefore investigated. METHODS: Bone cement (polymethylmethacrylate) was injected into three lumbar vertebrae in 12 sheep. Invasive blood pressures and heart rate were recorded continuously until 60 min after the last injection. Cardiac output and arterial and mixed venous blood gas variables were measured at selected time points. Before the first cement injection, 6 animals received a bolus injection (0.7 mg/kg) of sildenafil, with continuous infusion (0.2 mg . kg . h) thereafter. Postmortem lung and kidney biopsies were taken for semiquantitative analysis of intravascular fat. RESULTS: Fat embolism was associated with a transient increase (21 +/- 7mmHg) in pulmonary arterial pressure. A transient decrease in arterial blood pressure and temporary increases in central venous pressure and dead space were also observed. No significant changes in any cardiovascular variable were observed after fat embolism in the sildenafil group. There was significantly (P < 0.05) less intravascular fat in the lungs of the sildenafil (median count of 5 emboli per microscopic view) compared with the control group (median count of 1). CONCLUSIONS: Administration of sildenafil prevented the acute cardiovascular complications after bone marrow fat embolism in sheep.

BACKGROUND: Sudden, intraoperative cardiovascular deterioration as a result of pulmonary embolization of bone marrow fat is a potentially fatal complication during total hip and knee arthroplasty, intramedullary nailing, and spine surgery. Anesthetic management is challenging in the presence of increased right ventricular afterload due to pulmonary hypertension. Selective pulmonary vasodilation may be an appropriate prophylactic or therapeutic measure. The effect of sildenafil (phosphodiesterase inhibitor) on cardiovascular deterioration after bone marrow fat embolization was therefore investigated. METHODS: Bone cement (polymethylmethacrylate) was injected into three lumbar vertebrae in 12 sheep. Invasive blood pressures and heart rate were recorded continuously until 60 min after the last injection. Cardiac output and arterial and mixed venous blood gas variables were measured at selected time points. Before the first cement injection, 6 animals received a bolus injection (0.7 mg/kg) of sildenafil, with continuous infusion (0.2 mg . kg . h) thereafter. Postmortem lung and kidney biopsies were taken for semiquantitative analysis of intravascular fat. RESULTS: Fat embolism was associated with a transient increase (21 +/- 7mmHg) in pulmonary arterial pressure. A transient decrease in arterial blood pressure and temporary increases in central venous pressure and dead space were also observed. No significant changes in any cardiovascular variable were observed after fat embolism in the sildenafil group. There was significantly (P < 0.05) less intravascular fat in the lungs of the sildenafil (median count of 5 emboli per microscopic view) compared with the control group (median count of 1). CONCLUSIONS: Administration of sildenafil prevented the acute cardiovascular complications after bone marrow fat embolism in sheep.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2007
Deposited On:08 Dec 2009 15:19
Last Modified:06 May 2016 07:49
Publisher:Lippincott Wiliams & Wilkins
ISSN:0003-3022
Publisher DOI:10.1097/01.anes.0000267510.81759.aa
PubMed ID:17585218
Permanent URL: http://doi.org/10.5167/uzh-25442

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