Anesthetic considerations and management of bone cement implantation syndrome following hip hemiarthroplasty with long cemented stem: A case report

Bone Cement Implantation Syndrome (BCIS) is a recognized complication in orthopedic surgeries, particularly cemented hemiarthroplasty. Despite its prevalence, the optimal anesthetic approach for such cases remains debated. BCIS, commonly presenting as hypoxia and cardiovascular collapse, is attributed to an emboli-mediated model. Alternative pathophysiologic mechanisms include histamine release, hypersensitivity, and complement activation. Early detection through monitoring techniques such as capnography, pulse oximetry, and continuous electrocardiography is crucial for intervention. This case report presents a 72-year-old female with multiple comorbidities who developed Grade 2 BCIS during a right hip hemiarthroplasty with a long-cemented stem. The patient's medical history, clinical presentation, diagnostic evaluation, and management are discussed. While BCIS is a reversible intraoperative complication, prompt intervention is essential. Management involves treating cardiovascular collapse as right ventricular failure, utilizing fluid administration, pulmonary vasodilators, inotropes, and alpha-adrenergic agonists. The debate over the ideal anesthesia for BCIS prevention continues, emphasizing the need for comprehensive preoperative assessment and intraoperative monitoring.