{
  "abstract": "Background and Aims Cemented hip arthroplasty is frequently performed in elderly patients, but it carries significant risk in those with limited physiological reserve. Complications such as fat or cement embolism and intraoperative hypoperfusion can result in acute neurological decline, often with devastating outcomes. Bone cement implantation syndrome (BCIS) is a recognized perioperative complication characterized by hypoxia, hypotension, and loss of consciousness, particularly in high-risk populationsMethods An ASA IV 90-year-old woman with chronic kidney disease, COPD, chronic anemia, and moderate aortic stenosis underwent cemented right hip arthroplasty, due to hip fracture, under spinal anesthesia. Intraoperatively, it was documented a transient hypotension one minute during cement implantation (MAP < 60 mmHg), followed by a sudden decrease in consciousness. Postoperatively, she was admitted to the emergency room unresponsive and unable to follow commands. Initial brain imaging showed no acute findings. Within 24 hours, she progressed to coma. Given her poor premorbid function and the severity of neurological impairment, the medical team opted for conservative, comfort-based management.Results This case highlights the vulnerability of frail elderly patients to embolic and hypoperfusion-related neurological complications during cemented arthroplasty. Moreover, it focuses on the possible differential diagnosis associated with sudden neurologic deficit during a cemented arthroplasty: embolic event, including fat/cement embolism, and hypoperfusion. Cement-related embolic phenomena, though rare, can be fatal and are often radiologically silent. Factors such as advanced age, high ASA grade, and comorbidities like COPD increase the risk of severe BCISConclusions In very elderly patients undergoing major surgery, early recognition of catastrophic complications is essential. Elderly patients are more prone to intraoperative hypoperfusion or embolic intraoperative strokes. Cement complications should always be considered in cement arthroplasties.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology Department, ULSGE, Vila Nova de Gaia, Portugal"
      ],
      "name": "José Miguel Lourenço"
    },
    {
      "affiliations": [
        "Vila Nova de Gaia, Portugal"
      ],
      "name": "Marta Afonso"
    },
    {
      "affiliations": [
        "Anesthesiology Department, ULSGE, Vila Nova de Gaia, Portugal"
      ],
      "name": "Helena Barbosa"
    }
  ],
  "title": "P068 Acute neurological deterioration after cemented hip arthroplasty in a frail elderly patient: a case report",
  "uid": "2aeaf096-0b64-559e-a885-038a850d86e9"
}