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[Acute massive pulmonary embolism occurring during orthopedic surgery]
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 13, 2003
Summary
A sudden drop in oxygen saturation during orthopedic surgery indicated a massive pulmonary embolism (MPE). Transesophageal echocardiography (TEE) aided in diagnosing the intraoperative MPE, leading to successful emergent embolectomy.
Area of Science:
- Cardiology
- Anesthesiology
- Orthopedic Surgery
Background:
- Massive pulmonary embolism (MPE) is a rare but life-threatening complication during orthopedic surgery.
- Intraoperative MPE can present with sudden hemodynamic instability and hypoxemia.
- Early diagnosis and intervention are critical for patient survival.
Observation:
- A 38-year-old male patient undergoing tibial internal fixation developed sudden intraoperative hypoxemia.
- Transesophageal echocardiography (TEE) revealed right ventricular enlargement and right atrial thrombus.
- The patient subsequently experienced hemodynamic shock as the thrombus resolved spontaneously.
Findings:
- TEE is a valuable diagnostic tool for intraoperative massive pulmonary embolism.
- Emergent embolectomy under cardiopulmonary bypass can be life-saving in MPE.
- Successful surgical intervention led to an uneventful postoperative recovery.
Implications:
- This case highlights the importance of vigilant monitoring and rapid diagnostic capabilities during orthopedic procedures.
- TEE should be considered in the armamentarium for diagnosing intraoperative MPE.
- Prompt surgical intervention can significantly improve outcomes in patients with intraoperative MPE.