Anaes Cases · Venous thromboembolism prophylaxis
The intraoperative pulmonary embolism
The hot case — the intraoperative PE. The recognition (the sudden cardiovascular collapse, the rising airway pressure, the falling end-tidal CO2), the differential (the PE, the anaphylaxis, the pneumothorax, the gas embolism), the supportive management, and the consideration of the thrombolysis.
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Twenty minutes into the open lower-limb fracture fixation under the general anaesthesia (the patient intubated and ventilated), the heart rate rises from 80 to 130, the systolic BP falls from 130 to 70, the airway pressure rises from 20 to 38 cmH2O, and the end-tidal CO2 falls from 35 to 22 mmHg. The saturation is 92 per cent on the 100 per cent oxygen. The surgeon is operating on the leg. Diagnose and manage.[2]
References2ShowHide
- [1]Pannucci CJ, Swistun L, MacDonald JK, et al. Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score. Annals of surgery, 2017.PMID 28106607
- [2]Kopp SL, Vandermeulen E, McBane RD, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: ASRA Evidence-Based Guidelines (fifth edition). Reg Anesth Pain Med, 2025.PMID 39880411