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CARDIOVASCULAR ANESTHESIA

Acute Hemodynamic Collapse After Induction of General Anesthesia for Emergent Pulmonary Embolectomy

Peter Rosenberger, MD^*, Stanton K. Shernan, MD^*, Prem S. Shekar, MD, Jayshree K. Tuli, Sc, Thomas Weissmüller, MD, Sary F. Aranki, and Holger K. Eltzschig, MD, PhD

*Department of Anesthesiology, Perioperative and Pain Medicine, Division of Cardiac Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany

Address correspondence and reprint requests to Holger K. Eltzschig, MD, PhD, Assistant Professor of Anesthesiology, Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany. Address e-mail to heltzschig{at}partners.org.

Patients undergoing pulmonary embolectomy often experience hemodynamic deterioration during induction of general anesthesia (GA). Therefore, we studied the incidence and possible risk factors for hemodynamic deterioration during GA induction. Fifty-two consecutive patients undergoing emergent pulmonary embolectomy at our institution were included. Hemodynamic collapse after GA induction was defined as hypotension refractory to vasopressor, inotrope, or fluid administration, requiring cardiopulmonary resuscitation followed by urgent institution of cardiopulmonary bypass (CPB). Demographic variables, comorbidities, specific location of thromboemboli, preoperative inotropic support, and anesthetic drugs used for GA induction were evaluated as possible risk factors. After GA induction, hemodynamic collapse occurred in 19% of patients (n = 10). However, the occurrence of hemodynamic instability was not predicted by any of the evaluated risk factors. In addition, the incidence of in-hospital mortality did not differ between hemodynamically stable or unstable patients (10%; 4 of 42 versus 10%; 1 of 10 patients, respectively). In conclusion, hemodynamic deterioration after GA induction develops frequently during emergent pulmonary embolectomy. On the basis of our experience from this study and the unpredictable nature of hemodynamic deterioration, we suggest that patients undergoing pulmonary embolectomy should be prepared and draped before GA induction, and a cardiac surgical team should immediately be available for emergent institution of cardiopulmonary bypass.

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