Intra-operative collapse or death related to the use of acrylic cement in hip surgery

Six intra-operative deaths and two episodes of near-fatal hypotension occurred in 52 consecutive Hastings procedures (insertion of metal prosthesis grouted in acrylic cement) for subcapital fracture of the femoral neck. This high complication rate was identified by a system of clinical audit undertaken by members of the anaesthetic department.     

Results of a ventricular stimulation protocol using a maximum of 4 premature stimuli in patients without documented or suspected ventricular arrhythmias

A prospective study was undertaken to assess the results of an aggressive ventricular stimulation protocol in 52 nonmedicated patients without a documented or suspected ventricular arrhythmia (VA). Thirty-five patients had no structural heart disease, 8 coronary artery disease, 6 hypertrophic cardiomyopathy, 2 mitral valve disease and 1 patient had congestive cardiomyopathy. The patients were 12 to 72 years old. One to 4 ventricular premature beats (twice diastolic threshold, 2 ms in duration) were given during sinus rhythm and during ventricu lar pacing at 100 beats/min at the right ventricular apex. End points were initiation of 6 or more beats of VA or every extrastimulus brought to its refractory period. In 31 of 52 patients (60%), a VA was ini tiated (nonsustained polymorphic ventricular tachycardia in 24 patients, nonsustained mono morphic ventricular tachycardia in 2 and ventricular fibrillation requiring countershock in 5). Repetitive ventricular responses (RVR) (1 to 5 beats) were initiated in 46 patients. In 15 patients only RVRs were initiated. In 6 patients RVRs or VA were not initiated. At the end of the follow-up period (mean 14 months), no patient had spontaneous VA and all were alive. This study shows that ventricular stim ulation can result in initiation of VA in patients without clinical VA. Interpretation of results of pro grammed ventricular stimulation in patients without clinically documented VA should be made with caution.