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Massive intraoperative pulmonary embolism in a child
1Department of Anaesthetics, Southmead Hospital, Bristol.
Insights
A young girl experienced a massive pulmonary embolism during surgery for an artificial bladder sphincter. Prompt resuscitation stabilized her, with the diagnosis confirmed post-operatively via lung scan, despite no identifiable risk factors.
Area of Science:
- Cardiology
- Pulmonology
- Surgical Anesthesia
Background:
- Pulmonary embolism (PE) is a serious condition that can occur during surgical procedures.
- Artificial bladder sphincter implantation is a surgical intervention for urinary incontinence.
Observation:
- An 11-year-old girl developed sudden hemodynamic instability, including tachycardia, hypotension, and cyanosis, during artificial bladder sphincter surgery.
- The patient required extensive resuscitation measures, including oxygen, fluids, vasopressors, and chest compressions.
Findings:
- A massive pulmonary embolism was diagnosed post-operatively using a lung perfusion scan.
- No apparent pre-existing risk factors for venous thromboembolism were identified in the patient.
Implications:
- This case highlights the potential for massive pulmonary embolism in pediatric surgical patients, even without typical risk factors.
- Early recognition and aggressive resuscitation are critical for managing intraoperative pulmonary embolism.
- Further research may be needed to understand the specific risks associated with artificial bladder sphincter implantation in pediatric populations.
Abstract:
An 11-yr-old girl suffered a massive pulmonary embolus during an operation to insert an artificial bladder sphincter. Forty minutes after the induction of anaesthesia, the heart rate increased and she became hypotensive and deeply cyanosed. A definitive diagnosis was not made during surgery, but she improved after 45 min of resuscitation with 100% oxygen, infusion of normal saline, ephedrine (total 45 mg) and intermittent external cardiac massage. The diagnosis was proved the next day by lung perfusion scan. There were no apparent risk factors.