ABSTRACT
INTRODUCTION: So far, there has been no report addressing the actual rate of asymptomatic pulmonary embolism (PE). The present study was conducted to clarify the incidence and the characteristics of postoperative PE including asymptomatic cases in gynecologic oncology. METHODS: A total of 2107 gynecologic surgery cases that were performed from January 1996 to December 2006 at the National Kyushu Cancer Center were included. Pulmonary embolism was diagnosed using a lung scan, multi-detector row computed tomography, or pulmonary angiography. The clinical factors, including prophylaxis, were analyzed by univariate and multivariate analyses. RESULTS: PE was diagnosed in 45 patients (2.14%). Six (13.3%) of the 45 patients had respiratory symptoms or signs, and 16 patients (35.6%) had no symptoms or signs except for a SpO2 level decrease. PE was diagnosed within 4 days after the surgery in 42 patients (93.3%). There were 1 massive, 2 recurrent, and no fatal PEs. A multivariate analysis demonstrated the incidence of PE to be associated with age (odds ratio, 1.957; 95% confidence interval, 1.497-2.559), operation time (1.664; 1.180-2.346), body mass index (2.457; 1.735-3.479), surgical position (2.253; 1.468-3.458), and the use of a perioperative intermittent pneumatic compression device (0.389; 0.229-0.659). CONCLUSIONS: A substantial number of postoperative PEs were occult, and identification of high-risk patients and routine SpO2 level monitoring would reduce the diagnostic delay of PE after gynecologic surgery. Increasing age, longer operation time, and obesity were risks. The use of a perioperative intermittent pneumatic compression device in multimodal conditions might thus prevent PE.
Subject(s)
Genital Neoplasms, Female/complications , Genital Neoplasms, Female/surgery , Gynecologic Surgical Procedures/adverse effects , Postoperative Complications , Pulmonary Embolism/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Incidence , Middle Aged , Neoplasm Staging , Pulmonary Embolism/mortality , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
We report a patient who was suspected of transfusion-related acute lung injury. A 60-year-old man underwent emergency thoracotomy and hemostasis after pneumonectomy. The SpO2, decreased abruptly to 66% 90 minutes after transfusion of packed red blood cells and fresh frozen plasma. He was ventilated with 100% oxygen. The SPO2 returned to 100% in 3 minutes. Postoperative chest radiography showed diffuse pulmonary infiltrates. The pulmonary edema improved in 12 hours with mechanical ventilation.
Subject(s)
Pulmonary Edema/etiology , Transfusion Reaction , Acute Disease , Emergencies , Hemostasis , Hemothorax/surgery , Humans , Lung Neoplasms/surgery , Male , Middle Aged , Pneumonectomy , Postoperative Complications/surgery , Pulmonary Edema/therapy , Respiration, Artificial , Thoracotomy , Treatment OutcomeABSTRACT
Hyper-IgE syndrome is a rare immunodeficiency disorder characterized by recurrent skin and pulmonary infections and extremely elevated serum levels of IgE. A 6-year-old girl with hyper-IgE syndrome underwent appendectomy. Anesthesia was induced with sevoflurane. After insertion of a laryngeal mask, anesthesia was maintained with nitrous oxide, sevoflurane, and oxygen. There were no perioperative complications related to anesthesia and surgery.
