Fatal pulmonary embolism occurs in 0.1% to 0.26% of cases of spine fusion surgery. Early diagnosis of pulmonary embolism is difficult, and delay in treatment can lead to a fatal outcome. We report on a case of symptomatic pulmonary embolism which developed after induction of general anesthesia in a patient who had been immobile because of a previous spinal operation one week prior to this. Despite a negative preoperative ultrasound examination for deep vein thrombosis, the patient had developed a pulmonary embolism, which was diagnosed using intraoperative transesophageal echocardiography. Despite intensive cardiopulmonary resuscitation and thrombolytic therapy, the patient died within a few hours of diagnosis.

Cervical epidural injection is a common treatment for management of neck, shoulder, and upper extremity pain. Although several complications are possible, cardiopulmonary arrest and intraventricular pneumocephalus are rare serious complications, mainly occurring when the dura has been punctured. We report on a case of cardiopulmonary arrest and intraventricular pneumocephalus after cervical epidural injection with loss of resistance technique using air. After performance of cardiopulmonary resuscitation for 30 minutes, a pulse was regained; however, the patient’s mental status was coma. Despite receiving conservative treatment, the patient ultimately died without recovery of consciousness.