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Inhaled nitric oxide does not alter pulmonary or cardiac effects of fat embolism in dogs after cemented arthroplasty

  • Robert J. Byrick
  • J. Brendan Mullen
  • Patricia M. Murphy
  • J. Colin Kay
  • Thomas E. Stewart
  • Gerald Edelist
Laboratory Investigation
Accepted:

Abstract

Purpose

We examined the effect of inhaled nitric oxide (NO) on the acute pulmonary hypertension and right ventricular (RV) dilation after fat embolism.

Methods

A bilateral cemented arthroplasty (BCA), created fat embolism in 20 dogs. In Part A, 12 dogs were randomized to an NO group (n = 6, inhaled NO 40 ppm before BCA and throughout the study) or a control group (n = 6). In Part B, a third group of dogs (n = 8) were given NO 20–40 ppm 2–3 min after BCA when pulmonary artery pressure (PAP) increased. Transesophageal echocardiography (TEE) and invasive hemodynamic monitoring evaluated the hemodynamic response to BCA. Postmortem, quantitative morphometry was used to estimate the number of fat emboli and diameter of lung vessel occluded by fat.

Results

Part A: The increase in PAP in the NO group (16 ± 1 to 34 ± 9 mmHg) within three minutes of BCA was not different from that in the control group (14 ± 4 to 35 ± 9 mmHg). Within three minutes of BCA, TEE demonstrated RV dilation in all groups (P < 0.05) but there was no difference in the change in RV area in the NO and control groups. When NO was given after BCA, no difference in PAP or RV dilation was noted from that in the control group. There were no differences, at post mortem, between the groups in the diameter of lung vessel occluded by fat

Conclusion

Whether given before the embolic insult or two to three minutes after the onset of pulmonary hypertension, inhaled NO did not attenuate the acute pulmonary hypertension or RV dilation after cemented arthroplasty.

Keywords

Nitric Oxide Right Ventricular Pulmonary Artery Pressure Pulmonary Artery Occlude Pressure Right Atrial Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Étudier l’effet de l’oxyde nitrique inhalé (NO) sur l’hypertension pulmonaire aiguë et la dilatation du ventricule droit (VD) après une embolie graisseuse.

Méthode

Une arthroplastie bilatérale cimentée (ABC) a créé une embolie graisseuse chez 20 chiens. Dans la partie A de l’essai, 12 chiens ont été répartis de façon aléatoire vers un groupe NO (n = 6, 40 ppm de NO inhalé avant l’ABC et tout au long de l’étude) ou vers un groupe témoin (n = 6). Dans la partie B, un troisième groupe de chiens (n = 8) ont reçu 20]–40 ppm de NO, 2–3 min après l’ABC, au moment oú la pression de l’artère pulmonaire (PAP) s’est élevée. On a évalué la réponse hémodynamique à l’ABC par échocardiographie transœsophagienne (ETO) et par monitorage hémodynamique effractif. Après la mort, on a utilisé la morphométrie quantitative pour évaluer la proportion du système vasculaire pulmonaire obstruée par la graisse.

Résultats

Partie A: L’augmentation de PAP dans le groupe NO (16 ± I à 34 ± 9 mmHg), en moins de trois minutes suivant l’ABC, était semblable à celle du groupe témoin (14 ± 4 à 35 ± 9 mmHg). Moins de trois minutes après l’ABC, l’ETO a montré une dilatation du VD dans tous les groupes (P < 0,05) mais pas de différence intergroupe de changements survenus au VD. Aucune différence de PAP ou de dilatation du VD, en comparaison avec les chiens témoins, n’a été notée suivant l’administration de NO. À l’autopsie, il n’y avait pas de différence intergroupe quant au diamètre du vaisseau pulmonaire obstrué par la graisse.

Conclusion

Que le NO sort administré avant l’embolie ou deux ou trois minutes après le début de l’hypertension, il ne réduit pas l’hypertension pulmonaire aiguë ou la dilatation du VD à la suite d’une arthroplastie cimentée.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Robert J. Byrick
    • 1
  • J. Brendan Mullen
    • 3
  • Patricia M. Murphy
    • 2
  • J. Colin Kay
    • 1
  • Thomas E. Stewart
    • 3
  • Gerald Edelist
    • 2
  1. 1.Department of AnaesthesiaSt. Michael’s HospitalTorontoCanada
  2. 2.Department of AnaesthesiaSunnybrook Health Sciences CentreCanada
  3. 3.Department of Pathology and Laboratory Medicine, Mt. Sinai HospitalUniversity of TorontoCanada

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