Anaesthetic Management of Pulmonary Thromboendarterectomy

Abstract

Acute pulmonary embolism is a common complication which often afflicts hospitalized patients after trauma and surgery. The overall incidence in both medical and surgical patients is approximately 20 per 1000 hospital admissions with a mortality rate of about 25% of this figure (1). Usually medical treatment with anticoagulants and thrombolytic therapy resolves the disease process but occasionally surgical intervention is required when medical treatment has failed and a massive pulmonary embolism precipitates cardio-respiratory arrest. However, the surgical results of acute pulmonary embolectomy have been unimpressive since Trendelenberg proposed this heroic procedure in 1908; the first survivor was only reported in 1924 (2). In fact by 1961 when the first successful pulmonary embolectomy was performed with the aid of cardiopulmonary bypass, only 22 survivors of the Trendelenberg procedure were recorded in the literature — a mortality rate greater than 95 % (3).