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Canadian Journal of Anesthesia, Vol 38, 335-337, Copyright © 1991 by Canadian Anesthesiologists' Society

ARTICLES

Failure to awaken after general anaesthesia secondary to paradoxical venous embolus

S Liu, HS Holley, SD Stulberg and B Cohen
Department of Anesthesiology, Northwestern University School of Medicine, Chicago, Illinois.

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 cerebral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.




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Copyright © 1991 by the Canadian Anesthesiologists' Society.