[Case of postoperative pulmonary embolism after tonsillectomy in a healthy young woman].
An 18-year-old healthy woman with no previous history of coagulation disorders underwent general anesthesia for tonsillectomy. The procedure was uneventful. After the surgery, she was ordered to rest on bed overnight. The next day, the patient experienced transient syncope followed by hypotension (< 60 mmHg) and severe dyspnea. Epinephrine 2 mg administration restored the blood pressure promptly, yet dyspnea persisted. The lung-perfusion scintigraphy showed upper-lobe perfusion defect in the left lung and she was diagnosed as having pulmonary embolism. She received low-molecular-weight heparin and warfarin therapy and recovered fully. The postoperative laboratory analysis did not show thrombophilic disorders or prothrombotic state. The pulmonary embolism was speculated to have occurred due to deep vein thrombosis which developed after postoperative immobilization. The prophylactic maneuvers such as elastic stockings were not applied to the patient preoperatively, who had been considered unlikely to develop deep vein thrombosis. Although deep vein thrombosis in children and adolescence are rare, postoperative children should be monitored carefully for thrombotic complications. Postoperative bed rest should be minimized in terms of prevention of thrombosis.
Igarashi
Ayuko
A
Department of Anesthesiology and Intensive Care, Yamagata Prefectural Shinjo Hospital, Shinjo 996-0025.
Amagasa
Sumio
S
Yokoo
Noriko
N
D000293:Adolescent; D000768:Anesthesia, General; D000925:Anticoagulants / Q000008:administration & dosage; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014068:Tonsillectomy; D016896:Treatment Outcome; D020246:Venous Thrombosis; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin