Reversal of intraoperative myocardial ischemia with a hemoglobin-based oxygen carrier.

phylaxis. Conspicuous by its absence is any report of such devices precipitating an embolic event during general surgery. We cannot establish causality. It is possible that the embolism would have occurred irrespective of the placement of the sequential devices because of the presence of multiple risk factors in our patient, including age, obesity, malignancy, estrogen replacement hormones, and relative immobility (because of illness). Nevertheless, the temporal association between activation of the pneumatic device and sudden onset of symptoms at least suggests that the application of preventive measure may have paradoxically triggered a life-threatening complication. Such an anecdotal report should not be held up as the sole basis for changing clinical practice, particularly when benefits of these compression devices outweigh the risk of complication. However, we suggest that these well-intentioned prophylactic measures may have adverse consequences, particularly if they are not used appropriately. Clinicians who care for patients with moderate to high risk for DVT who are fitted with these devices should remain alert for signs and symptoms of acute embolism, especially during the first few minutes and hours after their application.