A fast-track diagnostic and therapeutic strategy for acute pulmonary embolism patients at peri-operational period

Acute pulmonary embolism (APE) in operation room is a constant, lethal but treatable disease. A fast determination of APE in an operation room is currently difficult due to a non-specificity on its signs, symptoms, electrocardiograph findings, arterial blood gas abnormalities and chest X-rays. Clinically, an APE can automatically originate from a small and clinically asymptomatic embolus to massive, proximal emboli with shock during a scheduled surgery period. An accurate, brief and prompt diagnostic and therapeutic strategy for APE in a peri-operation period is crucial for anesthesiologists to make a decision on an appropriate clinical intervention to improve patients' outcomes. The purpose of this mini-review article is to illuminate a fast-track diagnostic and therapeutic strategy for APE patients in a perioperative period through a hybrid of the high sensitive and high specific viable diagnostic modality of D-dimer assay in conjunction with necessary emergent pulmonary angiography (EPA), including digital subtraction angiography (DSA), or a spiral computed tomography angiography (sCTA) for APE patients' diagnosis and treatment during operation. The postulated fast-track diagnostic and therapeutic strategy can effectively confirm or exclude highly suspected APE and simultaneously provide fast therapeutic opportunities for APE patients at an operative period.