2011-8434-1-PB.pdf - Complete Cognitive Recovery and...

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62 PRHSJ Vol. 39 No. 1 • March, 2020 Complete Cognitive Recovery and Survival From Massive Pulmonary Embolism During General Anesthesia after Administration of Alteplase: A Case Report Hector Torres, MD; Marinell Rivera, MD; Laura Garcia, MD; Gabriel Altieri, MD Department of Anesthesiology, University of Puerto Rico Medical Sciences Campus, San Juan, PR The author/s has/have no conflict/s of interest to disclose. Address correspondence to: Hector Torres, MD, University of Puerto Rico Medical Sciences Campus, Department of Anesthesiology, Paseo Dr. Jose Celso Barbosa, San Juan, PR 00921. Email: [email protected] Presented herein is the case of a 37-year-old male who was scheduled for an anterior decompressive laminectomy after suffering trauma to the cervical area (C6–C7). An intraoperative acute pulmonary embolism (APE) was suspected after persistent hypoxemia and a decreased end-tidal CO2 that was refractory to proper management. After 6 intraoperative episodes of cardiac arrest that followed, intravenous alteplase (thrombolytic therapy) was administered, and the patient was stabilized without major complications. Eventually, APE was successfully diagnosed and treated. The experience served as reference for the diagnosis and management of APE under general anesthesia. [ P R Health Sci J 2020;39:62-63 ] Key words: Intra-operation, Pulmonary embolism, General anesthesia, Cardiac arrest A n acute pulmonary embolism (APE) is a life-threatening event for which early identification and management are key to improving the sufferer’s prognosis and survival. Deep vein thrombosis (DVT) is the main cause of an APE (1). In the United States, more than 100,000 patients die each year due to this complication (1). Although it is more commonly seen in the preoperative or postoperative period, cases have been reported to have occurred intraoperatively. Due to the effects of general anesthesia on the physiologic responses of the afflicted patient, the common signs and symptoms of an APE are blunted, which makes the prompt identification and treatment of this phenomenon even more difficult (2). Advances in biomedical technology, such as echocardiography and computed tomography angiography (CTA), have made the diagnosis and proper treatment of this disease more efficient, nowadays. Case Description Herein, we describe the case of a 37-year-old male patient who had been scheduled for an anterior decompressive laminectomy at C6–C7 5 days after his admission to our hospital posterior to having sustained a 10-story fall; he had no other trauma-related injuries. Previous to the traumatic event, the patient was in good health, with no past medical history of thrombotic disease.

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