Thrombolytic therapy for treatment of pulmonary embolism in the postoperative period: case report and review of the literature.
A patient with morbid obesity and insulin-dependent diabetes was admitted to the surgical intensive care unit, four days status postsurgical repair of an umbilical hernia. A pulmonary embolus (PE) was diagnosed by ventilation/perfusion scan and confirmed by transthoracic echocardiogram. A right ventricular ejection fraction/volumetric/oximetry pulmonary artery catheter revealed a very low ejection fraction and cardiac index. Systemic urokinase therapy was initiated and the patient improved considerably over the ensuing 12 hours. Anesthesiologists must be able to diagnose the signs and symptoms of PE and should be familiar with treatment modalities to reverse right ventricular dysfunction. Review of the literature regarding thrombolytic therapy in the perioperative period indicates potential benefit in select patients.
Hartmannsgruber
M W
MW
Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
Trent
F L
FL
Stolzfus
D P
DP
D000328:Adult; D002302:Cardiac Output; D002303:Cardiac Output, Low / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006554:Hernia, Umbilical / Q000601:surgery; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000150:complications; D011183:Postoperative Complications / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D013318:Stroke Volume; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000209:etiology
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator