# Profoundly Delayed Emergence due to Pulmonary Embolism

## TL;DR

A 12-year-old girl had a delayed recovery after surgery due to a rare complication called pulmonary embolism, which affected her breathing and response to anesthesia.

## Contribution

This case highlights a rare cause of delayed emergence from anesthesia linked to pulmonary embolism and sevoflurane retention.

## Key findings

- The patient showed acute hypercapnia and tachycardia after surgery.
- CT scans revealed partially occlusive pulmonary embolism in both lungs.
- The embolism caused a ventilation-perfusion mismatch and delayed emergence from anesthesia.

## Abstract

Pulmonary embolism is a rare, but serious, potential perioperative complication and crisis. We present a case of a 12-year-old female undergoing distal femoral and proximal tibial osteotomies with internal fixations who experienced acute onset hypercapnia, tachycardia, and prolonged minimal responsiveness following deflation of the tourniquet and cessation of inhaled sevoflurane. CT-chest demonstrated bilateral partially occlusive filling defects of the pulmonary vasculature. We concluded that the patient experienced a pulmonary embolism resulting in V/Q mismatch, retained sevoflurane, and ultimately delayed emergence.