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[Pulmonary and paradoxical embolism after total knee replacement--a case report]
Acta Anaesthesiologica Sinica
|June 1, 1996
Summary
Complications of orthopedic surgery using pneumatic tourniquets and bone cement, such as deep vein thrombosis and paradoxical embolism, can be fatal. This case highlights the severe risks associated with total knee replacement (TKR).
Area of Science:
- Orthopaedic Surgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Pneumatic tourniquets and bone cement are standard in orthopaedic procedures.
- Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) are known risks after lower limb surgery.
- Paradoxical embolism can occur in patients with right-to-left shunts.
Observation:
- A 60-year-old female underwent total knee replacement (TKR) with a 2-hour pneumatic tourniquet application.
- Postoperatively, the patient developed dyspnea, tachycardia, hypoxemia, and abdominal pain.
- Exploratory laparotomy revealed ischemic bowel and gallbladder.
Findings:
- Pulmonary embolism and paradoxical embolism were diagnosed as complications of TKR.
- These embolic events were attributed to tourniquet use and bone cement application.
- The patient experienced multiple organ failure.
Implications:
- This case underscores the potentially fatal risks of DVT, PE, and paradoxical embolism following TKR.
- Careful patient selection and monitoring are crucial when using pneumatic tourniquets and bone cement.
- Further research into preventative strategies for embolic complications in TKR is warranted.