Specific Case Complication Review

Temperature Management

Bone Cement Implantation Syndrome

• Methyl methacrylate cement: increases intramedullary pressure in bones causing micro emboli to be released. They lodge in lungs causing V/Q mismatch and can cause right heart failure

• Residual methyl methacrylate in the systemic circulation cases bradycardia, hypotension, and pulmonary HTN, hypoxia, cardiac arrest.

Post Op Vision Loss

• Central Retinal Artery Occlusion
  • Cardiac bypass
    • Showers of emboli
  • Moss common cause of retinal vision loss after nonocular sx
• Anterior Ischemic Optic Neuropathy
  • Globe pressure on optic disc
• Posterior Ischemic Optic Neuropathy
  • Most common adult post op blindness in prone spine sx
  • Theory:
    • Inc intraabdominal pressure, thoracic pressure, JVD, ocular pressure, causes venous congestion and compartment syndrome
  • Risks:
    • Wilson Frame, Obese, male, >50yrs, inc blood loss
  • Treatment
    • Transfuse early, keep MAP >70

Transfusion Related Acute Lung Injury TRALI

Signs and Symptoms

• Rapid onset dyspnea, hypoxia during or within 6 hours of transfusion
• Fever, cyanosis, hypotension
• Non cardiogenic pulmonary edema
• Tx with supportive care

Physiology

• Priming even such as infection, cytokine administration, surgery, burns that activates pulmonary endothelium
• Infusion of donor derived anti HLA (part of MHC class) or anti HNA antibodies directed against antigens on the neutrophil surface

Positioning of Hands/Arms

• Palm up or pinky down never palm down