[A survival case of intraoperative pulmonary embolism diagnosed early by transesophageal echocardiography].
An otherwise healthy 36-year-old housewife was diagnosed with advanced cancer of the stomach 5 months after her third parturition. Surgery was performed with the patient under total intravenous anesthesia combined with continuous epidural anesthesia. The course of anesthesia and the operative course were uneventful until the abdominal skin was sutured, when unexplained severe circulatory collapse developed. A widely dissociated PETCO2- PaCO2 suggested pulmonary embolism, and the findings of transesophageal echocardiography corroborated the diagnosis. Infusion of 480,000 units of urokinase in 30 minutes was immediately started via a Swan-Ganz catheter, and intravenous heparin 10,000 units in 24 hours, was administrated continuously. The pulmonary circulation was restored 30 minutes after the start of therapy, resulting in rapid recovery of the patient's systemic circulatory and acid-base status. The patient was safely extubated 19 hours postoperatively.
Shiraishi
M
M
Department of Anesthesiology, Juntendo University Urayasu Hospital.
Mizumura
K
K
Hanzawa
K
K
Wachi
Y
Y
Nitami
K
K
Kamiyama
Y
Y
D000328:Adult; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D000925:Anticoagulants / Q000008:administration & dosage; D018279:Carcinoma, Signet Ring Cell / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010960:Plasminogen Activators / Q000008:administration & dosage; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013274:Stomach Neoplasms / Q000601:surgery; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D000925:Anticoagulants; D006493:Heparin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator