Download PDF
CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0045-1805055
Case Report

Pulmonary Embolism and Posterior Circulation Infarcts Following Position Change from Prone to Supine during Cervical Spine Surgery: A Case Report

Anirban B. Adhikary
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Priyanka Gupta 
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Ramanand V. Jadhav
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Ranjay Mahaseth
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Abstract

Acute massive pulmonary embolism (PE) is a lethal condition unless promptly detected and managed. Diagnosing and managing massive PE during the perioperative period can be challenging due to overlapping clinical signs with other complications. This case report highlights the challenges of diagnosing and managing a massive PE in a patient with morbid obesity who underwent instrumentation of the cervical spine at multiple levels and developed cardiac arrest while turning the patient supine from the prone position. With the help of focused cardiac ultrasound, we suspected PE, which was later confirmed on imaging. Postoperative brain imaging also confirmed the presence of multiple embolic infarcts in the occipital and cerebellar hemispheres.

Keywords

pulmonary embolism - prone position - cervical vertebral fusion - vertebral artery insufficiency - posterior circulation brain infarction


Publication History

Article published online:
29 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Pharo GH, Andonakakis A, Chandrasekaren K, Amron G, Levitt JD. Survival from catastrophic intraoperative pulmonary embolism. Anesth Analg 1995; 81 (01) 188-190
    PubMedSearch in Google Scholar
  • 2 Sharma J, Walia HS, Jaswal S, Goyal A. Diagnosis and management of intra-operative pulmonary embolism under general anaesthesia in a peripheral tertiary care centre with limited resources. Indian J Anaesth 2022; 66 (Suppl. 02) S131-S132
    PubMedSearch in Google Scholar
  • 3 Hotoleanu C. Association between obesity and venous thromboembolism. Med Pharm Rep 2020; 93 (02) 162-168
    PubMedSearch in Google Scholar
  • 4 Peng YH, Liao WC, Chung WS. et al. Association between obstructive sleep apnea and deep vein thrombosis / pulmonary embolism: a population-based retrospective cohort study. Thromb Res 2014; 134 (02) 340-345
    CrossrefPubMedSearch in Google Scholar
  • 5 Hovav T, Yedgar S, Manny N, Barshtein G. Alteration of red cell aggregability and shape during blood storage. Transfusion 1999; 39 (03) 277-281
    PubMedSearch in Google Scholar
  • 6 Gebhard CE, Zellweger N, Gebhard C. et al. Prone positioning as a potential risk factor for deep vein thrombosis in covid-19 patients: a hypothesis generating observation. J Clin Med 2021; 11 (01) 103
    CrossrefPubMedSearch in Google Scholar
  • 7 Yi HJ. Epidemiology and management of iatrogenic vertebral artery injury associated with cervical spine surgery. Korean J Neurotrauma 2022; 18 (01) 34-44
    PubMedSearch in Google Scholar
  • 8 Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg 2020; 6 (01) 302-322
    CrossrefPubMedSearch in Google Scholar
  • 9 Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 2012; 8 (02) 199-207
    CrossrefPubMedSearch in Google Scholar