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Management of intra-operative acute pulmonary embolism during general anesthesia: a case report

BACKGROUND: Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which...

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Autores principales: Mao, Yuanyuan, Wen, Shuai, Chen, Gezi, Zhang, Wei, Ai, Yanqiu, Yuan, Jingjing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446758/
https://www.ncbi.nlm.nih.gov/pubmed/28549416
http://dx.doi.org/10.1186/s12871-017-0360-0
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author Mao, Yuanyuan
Wen, Shuai
Chen, Gezi
Zhang, Wei
Ai, Yanqiu
Yuan, Jingjing
author_facet Mao, Yuanyuan
Wen, Shuai
Chen, Gezi
Zhang, Wei
Ai, Yanqiu
Yuan, Jingjing
author_sort Mao, Yuanyuan
collection PubMed
description BACKGROUND: Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. CASE PRESENTATION: We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in P(ET)CO(2) and increase in PaCO(2) combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient’s family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. CONCLUSIONS: Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in P(ET)CO(2) and increase in PaCO(2) might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12871-017-0360-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-54467582017-05-30 Management of intra-operative acute pulmonary embolism during general anesthesia: a case report Mao, Yuanyuan Wen, Shuai Chen, Gezi Zhang, Wei Ai, Yanqiu Yuan, Jingjing BMC Anesthesiol Case Report BACKGROUND: Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. CASE PRESENTATION: We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in P(ET)CO(2) and increase in PaCO(2) combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient’s family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. CONCLUSIONS: Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in P(ET)CO(2) and increase in PaCO(2) might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12871-017-0360-0) contains supplementary material, which is available to authorized users. BioMed Central 2017-05-26 /pmc/articles/PMC5446758/ /pubmed/28549416 http://dx.doi.org/10.1186/s12871-017-0360-0 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Mao, Yuanyuan
Wen, Shuai
Chen, Gezi
Zhang, Wei
Ai, Yanqiu
Yuan, Jingjing
Management of intra-operative acute pulmonary embolism during general anesthesia: a case report
title Management of intra-operative acute pulmonary embolism during general anesthesia: a case report
title_full Management of intra-operative acute pulmonary embolism during general anesthesia: a case report
title_fullStr Management of intra-operative acute pulmonary embolism during general anesthesia: a case report
title_full_unstemmed Management of intra-operative acute pulmonary embolism during general anesthesia: a case report
title_short Management of intra-operative acute pulmonary embolism during general anesthesia: a case report
title_sort management of intra-operative acute pulmonary embolism during general anesthesia: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446758/
https://www.ncbi.nlm.nih.gov/pubmed/28549416
http://dx.doi.org/10.1186/s12871-017-0360-0
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