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Anesth Analg 2008; 107:221-225
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181770abb
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NEUROSURGICAL ANESTHESIOLOGY

Cerebral Microemboli During Hip Fracture Fixation: A Prospective Study

Michal Barak, MD*, Majed Kabha, MD{dagger}, Doron Norman, MD{ddagger}, Michael Soudry, MD§, Yeshayahu Kats, MD, DSc*, and Simcha Milo, MD{dagger}

From the Departments of *Anesthesiology, {dagger}Cardiac Surgery, {ddagger}Orthopedic Surgery B, and §Orthopedic Surgery A, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Address correspondence and reprint requests to Simcha Milo, MD, Department of Cardiac Surgery, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel. Address e-mail to smilo{at}rambam.health.gov.il.

Abstract

BACKGROUND: Recent studies have shown that cerebral fat microembolism takes place during surgery for hip or knee replacement. In this study, we examined the occurrence of cerebral microembolism, solid or gas, during a standard procedure of hip fracture fixation.

METHODS: This was a prospective study of patients who underwent urgent surgery with a dynamic hip screw for hip fracture fixation. During surgery, patients were monitored with transcranial Doppler for detection of microemboli from right and left middle cerebral arteries.

RESULTS: Twenty-two patients were included in the study; their median age was 82 yr (range, 51–97 yr). In nine (41%) patients, high intensity transient signals were recorded, indicating microemboli passage in the middle cerebral arteries. All nine patients had signals of both solid and gas emboli. One of these nine patients had a postoperative cerebrovascular accident.

CONCLUSIONS: The incidence of cerebral microemboli during urgent surgery for hip fracture fixation is considerable. This phenomenon is not confined to hip or knee replacement surgery. The clinical implications of this finding require further investigation.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.