THROMBOEMBOLISM COINCIDENT WITH TOURNIQUET DEFLATION DURING TOTAL KNEE ARTHROPLASTY

Despite prophylactic therapy, pulmonary embolism remains the leading c ause of perioperative mortality in patients undergoing total knee arth roplasty (TKA). We used transoesophageal echocardiography to monitor 2 9 consecutive patients during TKA. Showers of substantial amounts of e chogenic material, lasting for 3-15 min, were visible in the right atr ium and ventricle within 10-15 s of tourniquet deflation in all patien ts. A 3 x 6 mm fresh thrombus was aspirated from the central circulati on of one patient. Another patient, who had had a Greenfield filter pl aced for previous thromboembolism, showed very little echogenic materi al after tourniquet deflation. The composition and importance of these echogenic emboli remain uncertain.