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Anesth Analg 2004;98:1184-1186
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000104585.83801.C5

GENERAL ARTICLES

Severe Hypercapnia Due to Pulmonary Embolism of Polymethylmethacrylate During Vertebroplasty

Kay Stricker, MD*, Rene Orler, MD{dagger}, Katrin Yen, MD{ddagger}, Jukka Takala, MD, PhD§, and Martin Luginbühl, MD*

Departments of *Anesthesiology and {dagger}Orthopedic Surgery, University Hospital of Bern, Switzerland; and {ddagger}Institute for Legal Medicine and §Department of Intensive Care Medicine, University of Bern, Switzerland

Address correspondence to Kay Stricker, MD, DEAA, Department of Anesthesiology, University Hospital, CH-3010 Bern, Switzerland. Address e-mail to Kay.Stricker{at}insel.ch Reprints will not be available from the authors.

Pulmonary polymethylmethacrylate embolism is a rare but potentially fatal complication of percutaneous vertebroplasty. Clinical signs are typical for pulmonary embolism: they include respiratory distress, hypotension, and decreases in end-tidal CO2. We report a case of fatal pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty that initially presented with hypertension (arterial blood pressure 190/90 mm Hg), normocardia, and hypercapnia (PaCO2 96 mm Hg), along with loss of consciousness. Several pieces of polymethylmethacrylate were found in the pulmonary vasculature at autopsy.

IMPLICATIONS: Osteoporotic spine fractures are increasingly treated by injection of bone cement into the vertebral body. Polymethylmethacrylate embolism is a rare but potentially fatal complication. We report on a case of polymethylmethacrylate embolism that was at first unrecognized because of uncharacteristic signs and symptoms.




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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 © 2004 by the International Anesthesia Research Society.