31 August 2016
: Case report
Successful Management of Intraoperative Acute Bilateral Pulmonary Embolism in a High Grade Astrocytoma Patient
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
Wail N. KhraiseADE, Mohammed Z. AllouhDE, Mohammad Y. HiasatB, Raed S. SaidEDOI: 10.12659/AJCR.898912
Am J Case Rep 2016; 17:632-636
Abstract
BACKGROUND: Intraoperative pulmonary embolism (PE) is a rare life-threatening complication in patients undergoing surgical intervention. Generally, cancer patients have a higher risk for developing this complication. Unfortunately, there is no standard procedure for its management.
CASE REPORT: We report the case of a 39-year-old woman with high-grade glioma in the right frontal lobe who was admitted to the surgical theater for craniotomy and excision of the tumor. During the general anesthesia procedure and just before inserting the central venous line, her end-tidal CO2 and O2 saturation dropped sharply. The anesthesiologist quickly responded with an aggressive resuscitation procedure that included aspiration through the central venous line, 100% O2, and IV administration of ephedrine 6 mg, colloid 500 mL, normal saline 500 mL, and heparin 5000 IU. The patient was extubated and remained in the supine position until she regained consciousness and her vital signs returned to normal. Subsequent radiological examination revealed a massive bilateral PE. A retrievable inferior vena cava (IVC) filter was inserted, and enoxaparin anticoagulant therapy was prescribed to stabilize the patient’s condition. After 3 weeks, she underwent an uneventful craniotomy procedure and was discharged a week later under the enoxaparin therapy.
CONCLUSIONS: The successful management of intraoperative PE requires a quick, accurate diagnosis accompanied with an aggressive, fast response. Anesthesiologists are usually the ones who are held accountable for the diagnosis and early management of this complication. They must be aware of the possibility of such a complication and be ready to react properly and decisively in the operation theater.
Keywords: Resuscitation, Neurosurgery, enoxaparin, Anesthesia, Vena Cava Filters
802 7
In Press
05 Jun 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939156
05 Jun 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.940291
05 Jun 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939840
02 Jun 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.940045
Most Viewed Current Articles
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
13 Jul 2022 : Case report
DOI :10.12659/AJCR.936441
Am J Case Rep 2022; 23:e936441
07 Dec 2021 : Case report
DOI :10.12659/AJCR.934347
Am J Case Rep 2021; 22:e934347
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250