DIAGNOSTIC AND THERAPEUTIC ASPECTS OF PER IOPERATIVE PULMONARY THROMBOEMBOLISM

Pulmonary embolism is a major cause of postoperative problems, account ing for 12-20% postoperative deaths. 0.1% to 0.4% of all hospitalised patients die due to acute pulmonary embolism. Thus, pulmonary embolism should be included in the differential diagnostic considerations. Blo od gas analysis, ECG, chest roentgenography, scintigraphy, pulmonary a rterial catheterisation, echocardiography, digital subtraction angiogr aphy, and angiography are important diagnostic tools. When pulmonary e mbolism is not life-threatening, heparinisation may be an adequate the rapeutic approach. In the case of severe cardiovascular instability, r ecanalisation of the pulmonary arterial tree has to be achieved. Recen t studies show that preceding surgery may not be an absolute contraind ication to thrombolysis. Recommendations for thrombolytic therapy incl ude the bolus administration of 250,000 U of urokinase followed by a c ontinuous infusion of 40-60,000 U per hour. In an emergency situation, a bolus dose of 1-2,000,000 U may be administered. A neurosurgical op eration in the preceding 10 days is still considered an absolute contr aindication to thrombolysis. Patient outcome in the case of cardiopulm onary resuscitation for massive pulmonary embolism may be improved by the bolus application of 2-3,000,000 U of urokinase. In addition or al ternatively, mechanical thrombus fragmentation via catheter or surgica l embolectomy may be used in certain hospitals.