Anesthetic management of minimally invasive pulmonary thrombo-embolectomy

Percutaneous Thrombo-embolectomy is a less invasive alternative therapeutic strategy that can be used for the treatment of acute pulmonary embolism (PE). It is usually performed in patients with acute high-risk (massive) PE for whom thrombolysis is contraindicated or has failed and for whom surgical intervention is not available or is contraindicated. These patients are at high risk for cardiopulmonary complications. The procedure is usually done in an interventional radiology suite or the hybrid operating rooms. Anesthetizing these patients that are at risk for hemodynamic and respiratory problems including right heart failure, hypoxia, and respiratory failure can be very challenging. In this chapter, the pre-operative assessment, the intra-operative management, and the postoperative course of the patients coming in for a Percutaneous Pulmonary Thrombo-embolectomy procedure are described.