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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of continuous epidural anesthesia and of general anesthesia on the incidence of thromboembolism following total hip replacement were studied. Sixty patients were randomly allotted to one of two groups receiving either epidural or general anesthesia. Epidural anesthesia (N = 30) consisted of 0.5% bupivacaine with epinephrine intraoperatively; for pain relief in the postoperative period (24 h), 0.25% bupivacaine with epinephrine was given every 3 h. General anesthesia (N = 30) consisted of controlled ventilation with N2O-O2 and intravenous fentanyl and pancuronium bromide; postoperatively, narcotic analgesics were given intramuscularly on demand for pain relief. Significantly lower frequencies were found following epidural anesthesia than after general anesthesia in deep venous thrombosis involving the popliteal and femoral veins (13% and 67%, respectively), deep venous thrombosis involving both calf and thigh veins (40% and 77%), and pulmonary embolism (10% and 33%). Possible explanations for these differences include increased circulation in the lower extremities, less tendency for intravascular clotting to occur, and more efficient fibrinolysis in association with continuous epidural anesthesia. The decrease in blood loss associated with epidural anesthesia with lower transfusion requirements also might play a role. Epidural analgesia prolonged into the postoperative period, in addition to other appropriate thromboprophylactic measures, should be of value in patients undergoing operations associated with a high risk of thromboembolic complications.
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PMID:Thromboembolism after total hip replacement: role of epidural and general anesthesia. 682 20

Sixty elderly patients were given at random either epidural analgesia with bupivacaine 0.75% or general anaesthesia with thiopentone, fentanyl, pancuronium, N2O/O2 for total hip replacement. Preoperatively the patients were of equal physical status with normal and similar laboratory values. All patients were mentally normal for their age. On the 1st postoperative day, the general anaesthesia group had a significantly lower than PaO2 than the epidural group (P less than 0.025). PaO2 in the general anaesthesia group was significantly lower than the preoperative value on the 1st and 3rd days (P less than 0.001 and P less than 0.01, respectively). None of the 29 patients in the epidural group but seven of 31 patients in the general anaesthesia group has significant mental changes postoperatively (P less than 0.01). Five of these patients still had mental changes which reduced the quality of life several months later. In the general anaesthesia group one patient died from acute myocardial infarction. Low postoperative PaO2 might have contributed to this death. Two patients in the epidural group had symptoms of pulmonary embolism postoperatively. Thus elderly patients appear to do better after hip replacement with less deterioration of cerebral and pulmonary functions when given epidural analgesia than when surgery is performed under general anaesthesia. These patients should therefore be offered epidural analgesia whenever possible.
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PMID:Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. 746 15

Pulmonary embolism (PE) is a major catastrophe during postoperative period. We had six patients who developed PE after surgery and one during anesthesia and surgery. Severe arterial hypoxemia (PaO2 41 +/- 14 mmHg) occurred in all six postoperative patients, but not in a patient who developed PE under anesthesia. In 3 patients with pulmonary artery catheter in place, pulmonary arterial pressure (PAP) increased significantly during the embolic events. PAP tended to decrease before the apparent improvement of PaO2 in each patient. This suggests that increases in anastomotic bronchial blood flow occurred following the events. In a patient who developed PE under enflurane-N2O-O2 anesthesia, neither hypoxemia nor hypotension occurred despite significant increase in PAP. All patients received heparin and urokinase intravenously, which caused persistent bleeding in two patients. It remains for further investigations to study the mechanisms of serious hypoxemia in postoperative patients with PE as well as those of favorably maintained pulmonary oxygenation in a patient with PE under general anesthesia.
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PMID:[Perioperative pulmonary thromboembolism. A clinical study]. 846 87

We report a case of intraoperative pulmonary embolism, detected by a sudden decrease in end-tidal carbon dioxide pressure (PETCO2). The patient was a 56-year-old female without any history of pulmonary disease. The patient was intubated and ventilated manually during the operation under anesthesia with sevoflurane, nitrous oxide, and vecuronium. The percutaneous oxygen saturation (SpO2) and PETCO2 were monitored continuously. Twenty minutes after starting the laparoscopic procedure, PETCO2 decreased suddenly from values between 34 and 38 mmHg to 24 mmHg, and SpO2 decreased from 99% to 95%. Nitrous oxide was discontinued. Removal of the drape revealed profound subcutaneous emphysema. Postoperative pulmonary scanning revealed areas with reduced pulmonary perfusion (Fig. 2). An intravenous bolus of heparin (3000 IU) was given immediately, followed by 10,000 IU heparin over the next 24 hours. The patient was discharged on the fifteenth postoperative day without any sequelae. Although monitoring pulmonary arterial pressure is generally considered a more reliable method for the early detection of pulmonary embolism, an invasive monitoring procedure, such as the insertion of a Swan-Ganz catheter, is usually not indicated in laparoscopic surgery. For the early detection of pulmonary embolism, we therefore recommend the continuous monitoring of PETCO2 during laparoscopic surgery.
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PMID:[Pulmonary embolism during laparoscopic cholecystectomy detected by sudden decrease in end-tidal carbon dioxide pressure]. 1121 49

A 73-year-old male developed intra-operative pulmonary air embolism during cervical tumor resection under general anesthesia. Just after unexpected bleeding (about 700 ml) from the left subclavian vein, PetCO2 decreased suddenly from 32 mmHg to 22 mmHg, SpO2 decreased from 99% to 87% and systolic blood pressure decreased from 110 mmHg to 80 mmHg. Nitrous oxide was discontinued immediately, and blood transfusion and continuous infusion of dopamine (5 micrograms.kg-1.min-1) were started. In spite of the recovery of PetCO2 and blood pressure, hypoxemia (PaO2 54 mmHg at 100% oxygen) continued. The operation was discontinued and the patient was transferred to the intensive care unit. Postoperative chest radiograph showed findings of pulmonary edema. We suspected that the air embolism would have been induced by spontaneous respiration associated with the injury of the subclavian vein. Pulmonary edema may have been induced by pulmonary embolism and volume overload for the acute hemorrhage. The intra-operative pulmonary air embolism can be accelerated by use of nitrous oxide and spontaneous respiration.
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PMID:[Intra-operative pulmonary air embolism caused by left subclavian vein injury, during cervical tumor resection: a case report]. 1216 89

Nitrous oxide is a recreational drug gaining in popularity for its deemed innocence. However, side effects have recently been reported. In this case, a patient suffered major aortic arch thrombus resulting in arterial occlusion of his arm and temporary cerebral infarction and later deep venous thrombosis and pulmonary embolism. No common causes for thrombus in this high-flow vessel were identified. The authors state that the patient's chronic nitrous oxide abuse might have led to this thrombus, although it has never been described previously. This hypothesis is supported with laboratory tests at several presentations.
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PMID:Aortic arch thrombus caused by nitrous oxide abuse. 2994 88