Anesthetic management in patients having catheter-based thrombectomy for acute pulmonary embolism: A narrative review

• Published in: Journal of clinical anesthesia 2024-02, Vol.92, p.111281-111281, Article 111281
• Main Authors: Rössler, Julian, Cywinski, Jacek B., Argalious, Maged, Ruetzler, Kurt, Khanna, Sandeep
• Format: Article
• Language: English
• Subjects: Acute Disease; Anesthesia; Anesthetics; Blood clots; Blood pressure; Cardiovascular disease; Catheters; Consortia; Contraindications; Embolectomy; Endovascular; General anesthesia; Hemodynamics; Humans; Hypotension; Hypoxia; Management; Medical imaging; Medical personnel; Mortality; Oxygen therapy; Patients; Perioperative care; Pulmonary arteries; Pulmonary embolism; Pulmonary Embolism - surgery; Pulmonary embolisms; Pulmonary hypertension; Thrombectomy; Thrombectomy - adverse effects; Thrombectomy - methods; Thrombolytic Therapy - methods; Treatment Outcome; Veins & arteries; Venous access
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2023.111281

Pulmonary embolism is the third leading cause of cardiovascular death. Novel percutaneous catheter-based thrombectomy techniques are rapidly becoming popular in high-risk pulmonary embolism – especially in the presence of contraindications to thrombolysis. The interventional nature of these procedures and the risk of sudden cardiorespiratory compromise requires the presence of an anesthesiologist. Facilitating catheter-based thrombectomy can be challenging since qualifying patients are often critically ill. The purpose of this narrative review is to provide guidance to anesthesiologists for the assessment and management of patients having catheter-based thrombectomy for acute pulmonary embolism. First, available techniques for catheter-based thrombectomy are reviewed. Then, we discuss definitions and application of common risk stratification tools for pulmonary embolism, and how to assess patients prior to the procedure. An adjudication of risks and benefits of anesthetic strategies for catheter-based thrombectomy follows. Specifically, we give guidance and rationale for use monitored anesthesia care and general anesthesia for these procedures. For both, we review strategies for assessing and mitigating hemodynamic perturbations and right ventricular dysfunction, ranging from basic monitoring to advanced inodilator therapy. Finally, considerations for management of right ventricular failure with mechanical circulatory support are discussed. •Catheter-based thrombectomy of pulmonary embolism is becoming common.•Qualifying patients require complex anesthetic management.•Risk stratification tools can help in preprocedural anesthesia assessment.•Monitored anesthesia care is possible, but general anesthesia may be required.•Hemodynamic support can range from vasoactive medications to mechanical circulatory support.