Сognitive Dysfunction After Hip Replacement: Opportunities for Infusion Prevention

The aim of the study was to evaluate the effect of infusion therapy on postoperative fat globulemia and cognitive dysfunction in patients after hip replacement. Material and methods. In group I, patients received perioperative therapy with 0.9% NaCl solution, and in group II, during the operation — Sterofundin iso and a modified gelatin preparation Gelofuzin, and after the operation — Remaxol. Results. In group II, the number of embolus globules 2 hours after surgery was lower by 51.4%, followed by a faster decrease compared to group I. 3 days after the operation, the MMSE score in group II was higher than in the domains responsible for memory and speech. On day 15, the number of patients without cognitive dysfunction was almost 2 times higher. On day 30, there were no patients with severe cognitive impairment (20–23 points), in group II they were 11.3%. Discussion. The emulsifying effect of the drugs led to a decrease in embolic cerebral damage by fat globules that exceed the size of the shaped blood elements. This may be due to sorption of free fatty acids by modified gelatin and recovery of their utilization. Conclusions. А correlation was found between the appearance of large fat globules in the bloodstream and the development of cognitive dysfunction. Application Gelofuzin, Sterofundin iso and Remaxol reduces the severity of fat globules and cognitive dysfunction.

hip replacement, cognitive dysfunction, fat embolism, Gelofuzin, Sterofundin isotonic, Remaxol

1. Bedford P. Adverse cerebral effects of anæsthesia on old people. The Lancet. 1955;269(6884):259–263. DOI: 10.1016/s01406736(55)92689-1.

2. Brotfain E., Koyfman L., Kutz R., Frenkel A., Gruenbaum S.E., Zlotnik A., Klein M. Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure. Case Rep. Crit. Care. 2014;506503. doi: 10.1155/2014/506503.

3. Cannon J.W., Khan M.A., Raja A.S., Cohen M.J., Como J.J., Cotton B.A., Dubose J.J., Fox E.E., Inaba K., Rodriguez C.J., Holcomb J.B., Duchesne J.C. Damage control resuscitation in patients with severe traumatic hemorrhage. J. Trauma Acute Care Surg. 2017;82(3):605–617. doi: 10.1097/TA.0000000000001333.

4. Dunkel J., Roth C., Erbguth F., Dietrich W., Hügens-Penzel M., Ferbert A. Cerebral Fat Embolism: Clinical Presentation, Diagnostic Steps and Long-Term Follow-Up. Eur. Neurol. 2017;78(3–4):181–187. doi: 10.1159/000479002.

5. Ivkin А.А., Grigoriev E.V., Shukevich D.L. Diagnostics of cognitive dysfunction in patients in the intensive care wards. Messenger of Anesthesiology and resuscitation. 2018;3(15):47–55(In Russian). doi: 10.21292/2078-5658-2018-15-3-47-55.

6. Kellogg R.G., Fontes R.B.V., Lopes D.K. Massive cerebral involvement in fat emb1olism syndrome and intracranial pressure management. J. Neurosurg. 2013;119(5):1263–1270. doi: 10.3171/2013.7.JNS13363.

7. Khadjibaev A.M. Mirdzhalilov F.Kh. Quick diagnostics of fat embolism syndrome in patients with polytrauma. Shoshilinch tibbiyot axborotnomasi. 2018;11(2):19–23. (In Russian).

8. Koryachkin V.A. Postoperative delirium: risk factors and prevention in orthopaedics and traumatology (review).Traumatology and Orthopedics of Russia. 2013;2:128–135. (In Russian).

9. Kosova E., Bergmark B., Piazza G. Fat embolism syndrome. Circulation. 2015;131(3):317–320. DOI: 10.1161/CIRCULATIONAHA.114.010835.

10. Lari A., Abdulshakoor A., Zogheib E., Assaf N., Mojallal A., Lari A.R., Bauer C., Sinna R. How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options. Aesthet. Surg. J. 2019;277. doi: 10.1093/asj/sjz277.

11. Polushin Y.S. Polushin А. Yu., Yukina G.Yu., Kozhemyakina M.V. Postoperative cognitive dysfunction — what we know and where we go. Messenger of Anesthesiology and Resuscitation. 2019;1(16):19–28. (In Russian). DOI: 10.21292/2078-5658-2019-16-1-19-28.

12. Popovich I., Singh V., Vickery B. Perioperative support of a patient with fat embolism syndrome with extracorporeal membraneoxygenation. BMJ. Case Rep. 2019;12(5). doi: 10.1136/bcr-2018-227747.

13. Poredos P., Mavric A., Leben L., Poredos P., Jezovnik M.K. Total Hip Replacement Provokes Endothelial Dysfunction. Angiology. 2018;69(10):871–877. doi: 10.1177/0003319718774660.

14. Scott J.E., Mathias J.L., Kneebone A.C. Postoperative Cognitive Dysfunction after Total Joint Arthroplasty in the Elderly: A MetaAnalysis. J. Arthroplasty. 2014;29(2):261–267. doi: 10.1016/j.arth.2013.06.007.

15. Shubnyakov I.I., Tikhilov R.M., Nikolaev N.S., Grigoricheva L.G., Ovsyankin A.V., Cherny A.Zh., Drozdova P.V., Denisov A.O., Veber E.V., Kuz’mina I.V. [Epidemiology of Primary Hip Arthroplasty: Report from Register of Vreden Russian Research Institute of Traumatology and Orthopedics. Travmatologiya i ortopediya Rossii. 2017;23(2):81–101. (In Russian). DOI: 10.21823/23112905-2017-23-2-81-101.

16. Yakovlev A.Y., Belous M.S., Pevnev А.А., Ryabikov D.V. Experimental justification of the use of colloidal blood substitutes for fat globulemia. Obshchaya Reanimatologiya. 2018;5(14):50–57. (In Russian). DOI:10.15360/1813-9779-2018-5-50-57.

17. Yakovlev А.Yu. Belous M.S., Ryabikov D.V., Chistyakov S.I., Semenov V.B., Yakovleva А.N. The effect of a combination of colloidal and crystalloid blood substitutes on blood fat globules in patients with trauma. EHksperimental'naya i klinicheskaya farmakologiya. 2019;8(82):32–36. (In Russian). https://doi.org/10.30906/08692092-2019-82-8-32-36.

18. Berger M., Nadler J., Browndyke J., Posunammy V., Cohen J.H., Whitson H.E., Mathew J.P. Postoperative Cognitive Dysfunction: Minding the Gaps in our Knowledge of A Common Postoperative Complication in the Elderly. Anesthesiol. Clin. 2015;33(3):517–550. doi: 10.1016/j.anclin.2015.05.008.