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Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography


Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA

Correspondence Address:
Harendra Arora
Department of Anesthesiology, N2198 University of North Carolina Hospitals, Campus Box 7010, Chapel Hill, NC 27599 - 7010
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.129865

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Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 145-147

 

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A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP) for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE) demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations.






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Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA

Correspondence Address:
Harendra Arora
Department of Anesthesiology, N2198 University of North Carolina Hospitals, Campus Box 7010, Chapel Hill, NC 27599 - 7010
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.129865

Rights and Permissions

A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP) for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE) demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations.






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