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LETTER TO THE EDITOR

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

Department of Anaesthesia; Papworth Hospital; Cambridge, UK; joe.arrowsmith{at}papworth.nhs.uk

To the Editor:

Rosenberger et al. (1) reported their institutional experience of hemodynamic deterioration after induction of anesthesia for emergent pulmonary embolectomy. We believe that stronger consideration should be given to using femoro-femoral cardiopulmonary bypass prior to inducing anesthesia in patients with severe right ventricular dysfunction. The femoral vessels can be readily identified and cannulated under local anesthesia, and the procedure is well tolerated (2). The small risk of venous thromboembolism associated with instrumentation of the femoral vein in the setting of pulmonary embolism (3) has to be weighed against the substantial risk (19% in the series reported) of hemodynamic collapse on induction.

Gibbon’s animal experimentation led to the development of cardiopulmonary bypass (4). Ironically, the impetus was a patient who died during emergent pulmonary embolectomy at MA General Hospital.

REFERENCES

1. Rosenberger P, Shernan SK, Shekar PS, et al. Acute hemodynamic collapse after induction of general anesthesia for emergent pulmonary embolectomy. Anesth Analg 2006;102:1311–5.[Abstract/Free Full Text]
2. Arrowsmith JE, Dunning JJ, Gray SJ, et al. Anesthesia for ventricular assist device placement. J Cardiothorac Vasc Anesth 2001;15:274.[Web of Science][Medline]
3. Joels CS, Sing RF, Heniford BT. Complications of inferior vena cava filters. Am Surg 2003;69:654–9.[Web of Science][Medline]
4. Shumacker HB. The evolution of cardiac surgery. Bloomington IN: Indiana University Press, 1992:242–3.

This article has been cited by other articles:

				P. Rosenberger, H. K. Eltschig, and S. K. Shernan Acute Hemodynamic Collapse After Induction of General Anesthesia for Emergent Pulmonary Embolectomy Anesth. Analg., March 1, 2007; 104(3): 742 - 742. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Webb, S. T. Articles by Arrowsmith, J. E. Search for Related Content PubMed PubMed Citation Articles by Webb, S. T. Articles by Arrowsmith, J. E.