Failure to awaken after general anaesthesia secondary to paradoxical venous embolus

Spencer Liu, H. Steele Holley*, S. David Stulberg, Bruce Cohen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cérébral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.

Original languageEnglish (US)
Pages (from-to)335-337
Number of pages3
JournalCanadian Journal of Anaesthesia
Issue number3
StatePublished - Apr 1991


  • Complications: embolism
  • Embolism: cerebral, thromboembolism

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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