[Diagnosis and therapy of perioperative lung embolism]

Pulmonary embolism is a major cause of postoperative problems, accounting for 12-20% postoperative deaths. 0.1% to 0.4% of all hospitalised patients die due to acute pulmonary embolism. Thus, pulmonary embolism should be included in the differential diagnostic considerations. Blood gas analysis, ECG, chest roentgenography, scintigraphy, pulmonary arterial catheterisation, echocardiography, digital subtraction angiography, and angiography are important diagnostic tools. When pulmonary embolism is not life-threatening, heparinisation may be an adequate therapeutic approach. In the case of severe cardiovascular instability, recanalisation of the pulmonary arterial tree has to be achieved. Recent studies show that preceding surgery may not be an absolute contraindication to thrombolysis. Recommendations for thrombolytic therapy include the bolus administration of 250,000 U of urokinase followed by a continuous infusion of 40-60,000 U per hour. In an emergency situation, a bolus dose of 1-2,000,000 U may be administered. A neurosurgical operation in the preceding 10 days is still considered an absolute contraindication to thrombolysis. Patient outcome in the case of cardiopulmonary resuscitation for massive pulmonary embolism may be improved by the bolus application of 2-3,000,000 U of urokinase. In addition or alternatively, mechanical thrombus fragmentation via catheter or surgical embolectomy may be used in certain hospitals.