Typical case sharing of sudden bone cement reaction syndrome during the period of periana

Because bone cement reaction syndrome is limited to orthopaedics, fewer orthopaedic surgeries mean that anesthesiologists may be inexperiencedCoupled with the inconsistent response to bone cement reaction syndrome, there is no more guidance on the consensus of guidelines for diverse casesTherefore, we find a typical case to share with everyone, to remind everyone of the actual combat capabilityThe patient, a 63-year-old male, weighing 68kg and asaIII, was admitted to hospital with a fractured right femur and neck, and undergeneral editing 5 days later on a general anaesthetic undergoing right femur replacementhere to note that fractures and age are two factorspatients have prostatitis, prostate hypertrophy for 8 years, urine frequency, urine emergency, urine is not enoughPatients have a history of hypertension, coronary heart disease for 12 years, blood pressure of up to 165/110mmHg, not systematic treatmentIt is important to note that high blood pressure and coronary heart disease are significantly poorly controlledto listen to the double lung breathing sound, X-ray examination did not show significant abnormalitynote that, in the event of pulmonary embolism, X-ray chest stakes can show signs of pulmonary artery obstruction: regional lung textures become thinner, sparse or disappear, and the lung permeable brightness increasesPulmonary arterial hypertension and right ventricle enlargement: the dry and conjoined pulmonary artery in the lower right pulmonary artery widens or is associated with a severed sign, the pulmonary artery segment is bulging and the right ventricle expandsPulmonary tissue secondary changes: the microscopic shadow tip points to the wedge shadow of the lung door, the lung is not open or inwell30 minutes before surgery intramuscular injection of the ostridine 5mg, the eastern osteum 0.3 mgafter entering the operating room, there were no obvious abnormalities in the routine monitoring of electrocardiograms, blood pressure 141/93mmHg, pulse 89 times/min, SpO2 96%is still relatively normal so faranaesthetic induced medication:meditapyrine 3mg, fentanyl 0.2mg, relying on miter 14mg, Viku bromine 7mg intravenous injection, trachea intubation machine-controlled breathing, moisture volume 560ml, breathing rate 12 times / minute, blood pressure 135/92mmHg, heart rate 83 times / minutethe above induction intubation process, there is not too much need to be introducedTo be decomplimented, anesthesiologists have avoided the use of narcotic drugs that may cause histamine releaseIntravenous continuous pump-injection propofol (TCi target concentration 3.5 micrograms/ml), isofluoroethee inhalation maintenance 1% to 1.5% regulation, static suction complex maintenance anesthesiaConstant speed infusion riffentani 0.12 micrograms / (kg min), intermittent injection of viku bromine ammonium to maintain muscle pineBlood pressure was maintained at 130/90mmHg, with a heart rate of 85 times/pointin the crystal-glue ratio 1: 1 infusion, crystal fluid selection lactic acid Ringer liquid, colloidal selection of hydroxyethyl starchthe operation began for 60 minutes and the vital signs were stablebone cement into the myelin cavity 5 minutes later, tachycardia, heart rate from 90 times / minute to 140 times / minute, blood pressure from 132 / 79mmHg to 89 / 52mmHg, SpO2 86%, ST section significantly downshifted, ventricular arrhythmia, frequent ventricular period contractionFollow the heart rate slows down and the operation is stoppedveins given a single injection of dopamine, blood pressure rose to 102/63mmHg, heart rate of 120 times per pointAt this time, the ST segment and just now compared to some of the increase, still frequent chamber period contractionThen intravenously given 2mg of dopamine, blood pressure rose to 140/90mmHg, heart rate 120 times / point, pre-chamber contraction less than 5 times / minuteIt is important to note that the anesthesiologist is better off using a more single vascular active drug with a single receptor?for the heart rate is fast, intravenous give Esrol 20 mg, after administration blood pressure dropped to 105/65mmHg, heart rate 90 times / point, ST segment has a significant downward shift, room pre-contraction increased to 7 to 8 times / minuteit is important to note that between correcting heart rate and maintaining blood pressure, it is important to focus on the stability of blood pressure At this point, don't over-demand that your heart rate return to normal Therefore, the application of Ayslor is open to debate single static injection dopamine 3mg, Eslore 50mg added 50 ml of physiological saline pumping, blood pressure maintained at 130/80mmHg, heart rate 90 times / point, ST section gradually returned to the baseline, occasional ventricular period before contraction 1 to 2 times / minute is it appropriate to again to suggest the application of dopamine? Assuming that a pulmonary embolism does occur, the oxygenation capacity of the lungs will be greatly reduced, meaning that all organs, including the heart, are suffering from hypoxia And speeding up the heart rate undoubtedly increases the oxygen consumption of the heart Therefore, caution needs to be taken At the end of the operation, the patient resumed autonomous breathing, removed the trachea catheter, blood pressure 130/80mmHg, heart rate 95 times /min, blood oxygen saturation 98%, electrocardiogram is still shown as a mild downshift of ST segment, occasional ventricular contraction have serious hemodynamic events, should i consider entering the intensive care unit for deferred drainage? 6 hours after surgery follow-up eIE map ST segment has returned to the baseline, occasional chamber pre-contraction, 1 to 2 times / minute After 24 hours of follow-up, the vital signs were stable cases, which may occur in different hospitals and even between different physicians, but the general principles should be consistent So, what are your recommendations for handling this case? 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