title: Failure to awaken after general anaesthesia secondary to paradoxical venous embolus.
abstract: A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cerebral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.
authors.affiliation: Department of Anesthesiology, Northwestern University School of Medicine, Chicago, Illinois.
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.forename: H S
authors.initials: HS
authors.lastname: Holley
authors.forename: S D
authors.initials: SD
authors.lastname: Stulberg
authors.forename: B
authors.initials: B
authors.lastname: Cohen
mesh_terms: D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D002544:Cerebral Infarction / Q000209:etiology; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011674:Pulse / Q000502:physiology; D014474:Unconsciousness / Q000209:etiology*