Plasma levels of endothelin-1 after a pulmonary embolism of bone marrow fat
Krebs, Jorg, Ferguson, Stephen J., Nuss, Katja, Leskosek, Boris, Hoerstrup, Simon P., Goss, Benjamin G., Shaw, Sidney, & Aebli, Nikolaus (2007) Plasma levels of endothelin-1 after a pulmonary embolism of bone marrow fat. Acta Anaesthesiologica Scandinavica, 51(8), pp. 1107-1114.
Background. Embolization of bone marrow fat during orthopedic surgery can lead to potentially fatal, intraoperative cardiovascular deterioration. It has been reported that pulmonary vasoconstriction rather than mechanical blockage was the reason for pulmonary hypertension during fat embolism. Increased plasma levels of endothelin-1 (ET-1) have been observed after pulmonary air and thrombo-embolization. Thus, the role of ET-1 in the development of acute cardiovascular deterioration after bone marrow fat embolization was investigated.
Methods. Polymethylmethacrylate bone cement was injected into three lumbar vertebrae of 6 sheep and subsequent cardiovascular changes were recorded until 60min after the last injection. Invasive blood pressures and heart rate were recorded continuously. Cardiac output, arterial and mixed venous blood gas parameters were measured at selected time points. Post mortem, lung biopsies were taken for analysis of intravascular fat.
Results. Embolization of bone marrow fat resulted in a sudden (within 1min) and severe increase in pulmonary vascular resistance (150%) and pulmonary arterial pressure (>100%), which lasted for 9 minutes. Plasma concentrations of ET-1 were significantly increased 30min (50%) and 60min (60%) after embolization. Intravascular fat and bone marrow cells were present in all lung lobes.
Discussion. Endothelin-1 values were elevated 30min after embolization, however pulmonary arterial pressure had increased within 1min and had recovered 10min after embolization. Thus, ET-1 did not contribute to the acute cardiovascular changes after fat embolization. A reflex response to embolization may have elicited pulmonary vasoconstriction resulting in cardiovascular deterioration observed presently. Endothelin-1 may cause postoperative cardiovascular and respiratory complications after bone marrow fat embolization.
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|Item Type:||Journal Article|
|Additional Information:||For more information, please refer to the journal's website (see hypertext link) or contact the author.|
|Subjects:||Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Anaesthesiology (110301)|
|Divisions:||Past > QUT Faculties & Divisions > Faculty of Built Environment and Engineering|
Current > Institutes > Institute of Health and Biomedical Innovation
|Copyright Owner:||Copyright 2007 Blackwell Publishing|
|Deposited On:||23 Oct 2008|
|Last Modified:||29 Feb 2012 23:36|
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