Figure 61-3 Status of an 85-year-old woman who underwent primary total-hip replacement with a Richard screw with a long side plate. She had a history of chronic obstructive lung disease and osteoporosis. Pulmonary and radial artery pressures were stable until a 200-mm cemented femoral component was inserted (point A). One minute after impaction of the femoral component, pulmonary artery pressure increased acutely (point C), and arterial pressure decreased to 30 mm Hg. Epinephrine (25 µg) was injected through the distal port of the pulmonary artery catheter (point D). This resulted in a rapid restoration of arterial pressure, transient tachycardia, and stabilization of the pulmonary artery pressure. The hip was relocated at point B, which resulted in no change in pulmonary artery pressure. (Adapted from Sharrock NE: Anesthesia. In Rubash HE (ed): The Adult Hip. Philadelphia, Lippincott-Raven Publishers, 1998, pp 615–624.)