Postoperative sudden cardiac arrest after craniotomy with tumor removal in prone position: Massive pulmonary embolism
Keywords:
pulmonary embolism, cardiac arrest, craniotomy, proneAbstract
Background: A Thai 46-year-old woman with
essential hypertension was diagnosed right
cerebellopontine angle meningioma. She underwent
craniotomy with tumor removal under general
anesthesia with endotracheal tube intubation in
prone position for 11 hours. After the operation,
she was turned to supine position and the
electrocardiogram showed pulseless electrical
activity (PEA). CPR was done about 5 minutes and
the spontaneous circulation returned. At the ICU,
echocardiogram showed dilated right ventricle.
The computed tomography angiography (CTA) of
pulmonary artery showed massive pulmonary
embolisms in both main pulmonary arteries. She
was transferred to cardiac center and she was treated
by intralesional recombinant tissue plasminogen
activator (rtPA) injection. Finally, she could be
discharged with fully recovery.
References
Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the
diagnosis and management of acute pulmonary
embolism. Eur Heart J. 2014;35(43):3033–69.
2. Epstein NE. A review of the risks and benefits of differing
prophylaxis regimens for the treatment of deep venous
thrombosis and pulmonary embolism in neurosurgery.
Surg Neurol. 2005;64(4):295-301.
3. Desciak MC, Martin DE. Perioperative pulmonary
embolism: diagnosis and anesthetic management.
J Clin Anesth. 201;23(2):153-65.
4. Hsieh SW, Lan KM, Luk HN, Wang CS, Jawan B. Massive
pulmonary embolism presented as sudden cardiac
arrest in the immediate postoperative period after
laparoscopic hysterectomy. J Clin Anesth. 2003;15(7):
545-8.
5. Geerts WH. Prevention of venous thromboembolism
in high-risk patients. Hematology Am Soc Hematol Educ
Program. 2006:462-6.
6. Morres LK, Chan CM, Shorr AM. Prevention of Venous
Thromboembolism in Hospitalized Patients. In: The
American College of Chest Phy sicians. CHEST Physician
[Internet]. 2009 [cited 2017 April 21]:[about 12 p.].
Available from: http://www.chestnet.org/~/media/
chesnetorg/Publications/Documents/CHEST
Physician/Vol 4 2009/0209CP_ Suppl.ashx.
7. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama
CM, Lassen MR, et al. Prevention of venous
thromboembolism: American College of Chest Physicians
evidence-based clinical practice guidelines (8th edition).
Chest. 2008;133(6 Suppl):381S–453S.
8. Maccioli G. ACLS in the Perioperative Period (AACLS).
In: The American Society of Anesthesiologists. ASA
refresher courses in anesthesiology. Volume 40.
Philadelphia: Lippincott; 2012. p. 1–6.
9. Desbiens NA. Simplifying the diagnosis and
management of pulseless electrical activity in adults: a
qualitative review. Crit Care Med. 2008;36(2):391-6.
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