[Massive pulmonary thromboembolism during an orthopedic surgery in an obese patient]

Deep venous thrombosis (DVT) and the consequent pulmonary embolism (PE) are devastating complications in orthopedic surgery. We report a 45-year-old male patient who developed PE during an operation of proximal tibia fracture under general anesthesia. On mobilization of knee joint, end-tidal CO2 suddenly decreased from 28 to 18 mmHg. Sp(O2) decreased from 99 to 92%, but blood pressure was maintained. Postoperatively Sp(O2) was maintained 94-95% in room air, but sinus tachycardia over 120 beats x min(-1) continued. On postoperative day 1, the patient experienced dyspnea. In the chest CT scan, massive embolism was found in the bilateral main pulmonary arteries and both middle lobe as well as lower lobe arteries in the right lung. DVT was detected by enhanced CT scan of the lower extremity. This patient had many risk factors for PE such as obesity, smoking, immobilization and lack of thromboprophylaxis.