Abstract
A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cérébral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.
Résumé
Un patient qui ne s’est pas réveillé après une révision d’un remplacement total de la hanche de neuf heures sans complication apparente est présenté. Il n’y avail aucune altération hémodynamique ciinique importante durant l’opération el la saturation d’oxygène, la capnographie et l’équilibre acide base furent normaux à travers la procedure. Un CT scan cérébral en postop a démontré un grand infarctus de l’artère cérébral moyenne gauche avec un déplacement de la ligne médiane. A l’autopsie, on trouva un foramen oval non suspecte et une embolie veineuse dans l’artère carotide interne gauche probalement provenant du plexus veineux périprostatique avec un large infarctus dans le territoire de distribution des artères cérébrales moyenne et antérieure gauche. Les auteurs concluent quune embolie veineuse paradoxale massive peut survenir lors de la chirurgie avec des altérations hémodynamiques minimes.
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Liu, S., Holley, H.S., Stulberg, S.D. et al. Failure to awaken after general anaesthesia secondary to paradoxical venous embolus. Can J Anaesth 38, 335–337 (1991). https://doi.org/10.1007/BF03007624
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DOI: https://doi.org/10.1007/BF03007624