Journal d'anesthésiologie clinique : accès libre

COVID-19 Pandemic and Embolic Manifestations; Old Topic and a New Visit

Abstract

Nissar Shaikh, A Raju Vegesna, Ahmed Lafir Aliyar, Nabil A Shallik and Yasser Hammad

Perioperative embolism increases the risk of morbidity and mortality in surgical patients. Pulmonary Embolism (PE), Fat Embolism Syndrome (FES), and Vascular Air Embolism (VAE) are a relatively common embolic phenomenon in the perioperative period. Surgical intervention causes tissue injury, hypercoagulability, and venous stasis. The incidence of pulmonary embolism varies with the type of surgical interventions, and hip hemi-arthroplasty has a higher incidence, whereas the laparoscopic surgeries have a lower incidence of pulmonary embolism. Various risk predispose to a perioperative pulmonary embolism. CTPA (Computerized Tomographic Pulmonary Angiography) has high sensitivity and specificity for the diagnosis of pulmonary embolism. Unfractionated Heparin (UFH) should be started as soon as pulmonary embolism is suspected. FES is the organ dysfunction caused by fat emboli. FES can be diagnosed by using a combination of clinical criteria and imaging studies. Supportive care is the mainstay of treatment for FES while heparin, steroid, and dextran are not recommended. VAE is frequent in obstetric, laparoscopic, and neurosurgical surgeries. VAE is increasingly occurring in divers, aviators, and astronauts due to the dysbarism. VAE commonly manifests by respiratory, cardiogenic, and neurological manifestations. Treatment includes hyperbaric oxygen therapy, UFH, and lignocaine. The incidence of pulmonary embolism in ICU patients with COVID-19 range between (14-43)%, most of them on anticoagulants. The diagnosis is challenging. The raised D-Dimer is an indication to do CTPA (Computerized Tomographic Pulmonary Angiography).