Pulmonary thromboembolism after sub-arachnoid anesthesia in a patient with a right intertrochanteric compound fracture: Clinical case

Background: The authors describe a clinical case of pulmonary thromboembolism that arose after sub-arachnoid anesthesiain a patient undergoing osteosynthesis with screw due to an intertrochanteric fracture. This condition is a cardiovascular emergencysince it causes obstruction of the pulmonary vascular bed, which may lead to severe acute failure of the right ventricle with increasedrisk of death.Methods: On arrival in our hospital emergency room the patient was diagnosed with right compound intertrochanteric fracture.On the basis of the patient's history, clinical exam, hemodynamic parameters, and total-body CT, treatment by surgery was decidedby osteosynthesis with screw on the right femora utilizing sub-arachnoid anesthesia.Results: During the operation the patient experienced dyspnea and chest pain, progressive desaturation, tachynea, markedtachycardia, and arterial hypotension. At that point general anesthesia was induced immediately by endotracheal intubation. A chestx-ray during the operation revealed a massive right pulmonary embolism, confirmed after a few minutes by a D-dimer value>3500ng/ml. For that reason an intravenous administration of sodium enoxaparin 8000 I.U. was performed immediately.Conclusions: The authors believe that in a patient with traumatic fracture of the femora undergoing an orthopedic operationthe appearance of symptoms of severe hypoxia, tachypnea, dyspnea, marked desaturation, chest pain, tachycardia, and arterial hypotension,justify a suspicion of acute pulmonary thromboembolism.