Acute Intraoperative Pulmonary Embolism Management in the Era of Pulmonary Embolism Response Teams and Minimally Invasive Therapy: A Case Report

Intraoperative acute pulmonary embolism (PE) is a rare and life-threatening event with symptoms such as pleuritic chest pain, shortness of breath, and anxiety, which are easily masked by general anesthesia. To diagnose PE in a patient under general anesthesia, anesthesiologists must rely on alternative data points such as hypoxia, decreased end-tidal carbon dioxide (ETCO2), tachycardia, electrocardiogram changes, and intraoperative echocardiography. We present a case of acute intraoperative massive PE in a patient undergoing posterior spinal fusion. We discuss the management of acute perioperative PE, focusing on surgical risk, bleeding potential with thrombolytic therapies and anticoagulation, recent advances in catheter-based therapies, and the role of Pulmonary Embolism Response Teams (PERTs) in the assessment and perioperative management of high-risk patients.