Fehler und Gefahren der perioperativen Lysetherapie

Unexpected complication of massive intraoperative pulmonary embolism following elective sigmoidectomy in the supine position

We describe a case of massive intraoperative pulmonary thromboembolism during elective sigmoidectomy in the supine position. During recovery from anesthesia, the patient developed hemodynamic compromise and severe hypoxemia. Intravenous inotropes and mechanical ventilation were instituted. The abrupt onset of symptoms and the pulmonary artery catheter, chest radiograph, and transesophageal echocardiography findings suggested massive pulmonary thromboembolism as a possible cause of the hemodynamic compromise and hypoxemia. Emergent angiography could not be carried out due to the patient's poor clinical status. Lack of experience in performing embolectomy, along with contraindication for thrombolysis, imposed the use of intravenous heparin and hemodynamic support as the only appropriate therapeutic modality. After 2 days' aggressive hemodynamic and ventilatory support, the patient had an uneventful course, and was discharged from the intensive care unit (ICU) 14 days later.

Gerinnungsmonitoring mithilfe der Thrombelastographie bei Lungenembolie

Thrombelastography (TEG) is a bedside method used to determine coagulation parameters such as clot formation, stabilization and lysis. This report describes a case of cardiopulmonary arrest due to fulminant pulmonary embolism in a 42-year-old postpartum patient. We discuss the dynamics of coagulation parameters during CPR and thrombolysis complicated by bleeding, as assessed by TEG.