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Objective:To report the first aid and nursing care of a case of intracranial air embolism after CT-guided percutaneous lung biopsy.Methods:The 1 case with intracranial air embolism after CT-guided percutaneous lung biopsy was given a series of treatment and nursing measures, including on-site first aid, hyperbaric oxygen therapy, sequential oxygen therapy and phased rehabilitation in Zhujiang Hospital, Southern Medical University in November 2022.Results:By giving timely and effective treatment and nursing measures, the patient recovered well and was discharged after 12 days of hospitalization.Conclusions:Intracranial air embolism is a critical disease, which should be mainly prevented, recognized, diagnosed and treated with hyperbaric oxygen as soon as possible.
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Ocular venous air embolism(OVAE)is a rare and fatal complication in vitrectomy. Due to the proximity of the surgical site to the heart and its level above the heart, OVAE may be the most severe complication in the venous air embolism(VAE)caused by surgery. With the development of vitrectomy, perfusion cannulas in the suture-free state may slide outward, and the perfused gas can enter the suprachoroidal space, which results in tearing of the vortex veins. Choroidal vascular wounds resulting from trauma and endoresection of choroidal melanoma can expose directly in the perfused gas during vitreous cavity gas-liquid exchange. This makes it possible that the pressurized gas enters the circulatory system through the torn vortex veins or the anomalous choroidal venous openings, which leads to OVAE. Nowadays, the definition, pathogenesis, clinical presentation and prevention of OVAE are being refined. However, most vitreoretinal surgeons and anesthesiologists are still unaware of this iatrogenic complication. It will be helpful to detect this complication early and make emergency management in time by increasing the awareness of OVAE and develop effective prevention strategies. The prevention and control principles of OVAE can be continuously optimized by the combination of clinical and laboratory studies. It will be conducive to the establishment and improvement of emergency treatment and preventive measures of OVAE to fully understand the pathogenesis and clinical characteristics of OVAE, to pay attention to the characteristics of secondary lesions of OVAE, and to attach importance to multi-disciplinary cooperation.
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Introducción: En las últimas décadas el uso de la posición sentada ha disminuido en frecuencia a causa de 2 complicaciones mayores: el embolismo aéreo venoso y la hipotensión intraoperatoria. Sin embargo es innegable que la posición sentada ofrece una serie de ventajas al neurocirujano, el anestesiólogo y al electrofisiólogo. Materiales y métodos: Estudio retrospectivo de pacientes operados en dos instituciones de Tucumán, entre enero de 2015 y diciembre de 2019. Resultados: Se operaron un total de 119 pacientes en posición sentada por vía posterior. Conclusión: Se presentó la técnica de posición semisentada paso a paso y consejos específicos. Se ilustró la utilidad de la misma mediante la presentación de casos representativos
Introduction: In the last decades, the use of the sitting position has been abandoned due to 2 major complications: venous air embolism and intraoperative hypotension. However, it is undeniable that the sitting position offers a series of advantages to the neurosurgeon, the anesthesiologist and the electrophysiologist. Materials and methods: Retrospective study of patients operated at two institutions in Tucumán, between January 2015 and December 2019. Results: A total of 119 patients were operated in a sitting position and posterior approach. Conclusion: The sitting position technique was presented step by step in detail, with the key steps and a series of tricks. The usefulness of the position was illustrated by presenting representative cases
Subject(s)
Embolism, Air , Patient Positioning , Neurosurgeons , NeurosurgeryABSTRACT
@#Cerebral air embolism caused by lung cancer is extremely rare, especially if not associated with invasive procedures such as needle biopsy. We describe the case of an 86-year-old man with squamous cell lung carcinoma of the left lung. He developed a bad cough and subsequently suffered left hemiplegia. Brain computed tomography (CT) on admission showed no abnormal findings. Diffusion-weighted magnetic resonance (MR) imaging revealed high intensity lesions in the right frontal lobe and right parietal lobes. Repeated brain CT revealed air densities around the high intensity lesions on previous MR imaging, compatible with air embolism causing cerebral infarction. Chest CT confirmed a left pulmonary hilar mass invading the left pulmonary vein, left atrium, and main bronchus. Air densities were found in the left heart ventricle. These radiological findings were attributed to cerebral air embolism associated with advanced lung cancer. Shortly afterwards he died of progressive respiratory failure. Our case reveals two important aspects. First, cerebral air embolism can be caused by lung cancer invading the pulmonary vein, left atrium, and main bronchus without iatrogenic causes. Therefore, we should pay special attention to the etiology when the patients with lung cancer in the advanced stage developed cerebral infarction. Second, repeated CT is recommended if cerebral air embolism is suspected because initial head CT does not always reveal air bubbles.
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RESUMEN Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.
ABSTRACT We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.
Subject(s)
Adult , Humans , Male , Unconsciousness/etiology , Intracranial Embolism/diagnosis , Dyspnea/etiology , Air Travel , Seizures/etiology , Tomography, X-Ray Computed , Intracranial Embolism/etiologyABSTRACT
Coronary air embolism is a dreadful complication of cardiac intervention despite careful prevention. In literature reported complications of coronary air embolism ranges from clinically non significant events to cardiogenic shock, myocardial infarction and death. We report a case of massive coronary air embolism in right coronary artery, which results in hypotension and complete heart block in a 33 -year-old female undergoing elective closure of atrial septal defect (ASD) by percutaneous transcatheter intervention. The patient stabilized after timely measures like oxygen support, dopamine infusion, cardiac compression and repeated bolus injection of heparinized saline. She then underwent successful percutaneous ASD device closure.
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Cerebral air embolism (CAE) is a rare complication of various medical procedures. It manifests with symptoms similar to those of typical acute cerebral infarction, however the treatment is quite different. We present a case of arterial CAE that was associated with a disconnected central venous catheter and appeared as punctate dark signal intensities with aliasing artifacts on the susceptibility-weighted filtered phase magnetic resonance image. The susceptibility-weighted filtered phase image can be helpful for diagnosing CAE and the magnetic resonance imaging reflects the pathophysiology of CAE.
Subject(s)
Artifacts , Central Venous Catheters , Cerebral Infarction , Embolism, Air , Intracranial Embolism , Magnetic Resonance ImagingABSTRACT
Since the beginning of cardiac surgery, retained intracardiac air has been one of the important problems to be solved. While transesophageal echocardiography enabled visualization of the air, and de-airing procedures have been routinely carried out, they appear to vary much among institutions and are not necessarily based on firm scientific evidence. Thus, “de-airing” was chosen as the theme of the 2016 CVSAP (Cardiovascular surgery and Anesthesia and Perfusion) Symposium and a nation-wide questionnaire survey was carried out prior to it. This paper reports the results of this survey and illustrates “the best de-airing” at present, based on the literature review. The collection rate of the questionnaire survey was high : 77.9% (278/357) and 83.3% (85/102) from major institutions of surgeons and anesthesiologists, respectively, indicating a high level of interest. More than 90% of both considered de-airing as important since adverse events related to air embolism were actually encountered, including some critical ones. Most routinely performed de-airing procedures are posture change, lung inflation and aspiration through the vent cannulae. Direct aspiration of air is carried out in only one-third of institutions. Carbon dioxide insufflation is performed in 82.5% of institutions, mostly at a rate of 2∼3 L/min. However, not a few surgeons are skeptical of its significance. While many surgeons are grateful for collaboration by anesthesiologists, some expect more information sharing between them. They also expect better comprehension of “de-airing” and timely manipulation of extracorporeal circulation system by clinical engineers to avoid undesirable events. Some surgeons expressed a wish for a convenient device for de-airing. Furthermore, some questions to be solved in the future were raised, including how meticulously the bubbles should be removed or how efficient carbon dioxide insufflation is.
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Systemic air embolism is a rare but potentially fatal complication related to many factors. The purpose of this article is to alert clinicians once patients occurs an abnormal neurological and cardiovascular status, following minor traumatic treatment, air embolism should be considered. A 20-year-old man who presented with fungal pneumonia with lung cavities formation was admitted to an intensive care unit (ICU) and received positive airway pressure ventilation. Four days later, the fungal pneumonia was improved, but the patient's blood pressure and arterial oxygen saturation deteriorated, so computed tomography (CT) scans were preformed to reevaluate him. The scans detected air embolism in the left atrium and ventricle, ascending aorta, aortic arch and its branches (right brachiocephalic, bilateral common carotid and right subclavian arteries), descending aorta and right coronary artery. A CT scan of the abdomen revealed air in the spleen, cauda pancreatic, superior mesenteric artery and right external iliac artery. The patient died two days later from multiple organ dysfunction. We suggest that vascular air embolism should be considered under mechanical ventilation when patients' neurologic and cardiovascular status deteriorates, and hyperbaric oxygen therapy should be conducted immediately.
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PURPOSE: Complete removal of air bubbles from balloons for neurovascular angioplasty is cumbersome. We compared the preparation difficulty, air removal efficiency, and air collection pattern of six different balloon catheter preparation methods to propose a better preparation method for both initial and second balloon uses, especially for small-profile angioplasty balloon catheters. MATERIALS AND METHODS: A total of 18 neurovascular angioplasty balloon catheters with nominal diameters of 2 mm were prepared to test six different preparation methods: the instruction for use method (method A), simplified method using a syringe (method B) and four newly devised preparation methods using inflating devices (methods C–F). Serial radiographs were obtained while the balloons were gradually inflated. We measured the time for each preparation and the bubble number, analyzed their distribution in the balloon, and calculated the contrast filling ratio (contrast filling area/total balloon area) for initial and second ballooning. The whole process was repeated three times. RESULTS: The preparation time varied widely (11.5 seconds [method D] to 73.3 seconds [method A]). On initial inflation, the contrast filling ratio at 8 atm was the highest (100%) with methods A and F. On second inflation, the ratio was again highest with method A (99.5%), followed by method F (99.2%). Initial ballooning tended to show a uniform pattern of single bubble in the distal segment of the balloon; in contrast, second ballooning showed varying patterns in which the bubbles were multiple and randomly distributed. CONCLUSION: None of the six methods were able to completely exclude air bubbles from the balloon catheters including the second ballooning; however, the method of repeating aspiration with high-volume inflating device (method F) could be a practical option considering the simplicity and efficiency of preparation.
Subject(s)
Angioplasty , Angioplasty, Balloon , Catheters , Clothing , Embolism, Air , Equipment Failure , Inflation, Economic , Intracranial Arteriosclerosis , Methods , SyringesABSTRACT
Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es uno de los recursos terapéuticos más importantes para el manejo de las complicaciones biliares del trasplante hepático. Sin embargo, se pueden presentar varias complicaciones: pancreatitis aguda, hemorragia, perforaciones, infecciones y eventos adversos cardiopulmonares. La embolia aérea es una complicación muy infrecuente, severa y potencialmente fatal. Se reporta un caso de embolia aérea post-CPRE en una mujer de 55 años con antecedente de trasplante hepático y estenosis de la anastomosis biliar. Se discute la presentación clínica, el diagnóstico, el tratamiento y los posibles mecanismos involucrados en esta complicación.
Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important therapeutic resources for management of biliary complications of liver transplantation. However, several complications including acute pancreatitis, hemorrhage, perforations, infections and cardiopulmonary adverse events can occur. Air embolisms occur very infrequently but are severe and potentially fatal complications. We report a case of post-ERCP embolism in a 55-year-old woman with a history of liver transplantation and stenosis of the biliary anastomosis. The clinical presentation, the diagnosis, the treatment and the possible mechanisms involved in this complication are discussed.
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Humans , Female , Middle Aged , Pulmonary Embolism , Cholangiopancreatography, Endoscopic Retrograde , Liver Transplantation , Patients , Hemorrhage , InfectionsABSTRACT
La embolia aérea es una complicación quirúrgica potencialmente fatal, que debe manejarse rápida y precozmente, por lo que su reconocimiento temprano es esencial. Al tener una amplia gama de posibles manifestaciones clínicas, la sospecha diagnóstica en base al procedimiento quirúrgico es fundamental. Presentamos el caso de una paciente de 69 años sometida a una faco-vitrectomía con anestesia general que sufrió un colapso hemodinámico brusco durante la fase de intercambio aire/fluido.(AU)
: Venous air embolism is a potentially fatal surgical complication which must be managed quickly, so early recognition is essential. Having a wide range of possible clinical manifestations, it requires a high index of suspicion based on the surgical procedure.We report a case of a 69-year-old woman undergoing general anesthesia for phaco-vitrectomy who suffered a sudden hemodynamic collapse during the air fluid exchange phase.(AU)
Subject(s)
Humans , Female , Aged , Vitrectomy , Embolism, Air , Shock , Anesthesia, GeneralABSTRACT
The presence of gas in the cerebral vascular venous structures is a finding that we infrequently see in our specialty. On many occasions we cannot pinpoint the cause, alarming the clinician, suggesting unnecessary exams, hospitalizations and controls. We performed a review of the literature and a retrospective study with the cases that we have reported in computed tomography of the brain in our radiology service, from January 2010 to July 2017.
La presencia de gas en las estructuras vasculares venosas cerebrales es un hallazgo que vemos infrecuentemente en nuestra especialidad. En muchas ocasiones no podemos precisar la causa, alarmando al clínico, sugiriendo exámenes, hospitalizaciones y controles innecesarios. Realizamos una revisión de la literatura y un trabajo retrospectivo con los casos que hemos reportado en tomografías computadas de encéfalo en nuestro servicio de radiología, desde enero del 2010 a julio del 2017.
Subject(s)
Humans , Diagnostic Imaging , Embolism, Air/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Abstract We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment.
Resumo Relatamos um caso de embolia gasosa durante miomectomia abdominal. Embora a incidência exata de embolia gasosa não seja conhecida, a maioria dos casos relatados na literatura se refere à posição sentada em craniotomias. Muitos casos são subclínicos e os métodos diagnósticos têm diferentes graus de sensibilidade e especificidade. No momento da suspeita, a prevenção de qualquer êmbolo de ar subsequente é a chave fundamental do tratamento.
Subject(s)
Humans , Female , Adult , Embolism, Air/etiology , Embolism, Air/therapy , Uterine Myomectomy/methods , Intraoperative Complications/therapyABSTRACT
Cerebral air embolism is an uncommon disorder, but it can result in significant morbidity and even mortality. Cerebral air embolism during esophago-gastro-duodenoscopy is also rare, but has in recent years been repeatedly reported. We report here a patient with cerebral infarction due to air embolism during endoscopic variceal ligation in liver cirrhosis. The patient was later confirmed to have patent foramen ovale. To our knowledge, this is the first report of such a complication with underlying patent foramen ovale and portal hypertension, who did no have underlying malignancy
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Micro-emboli have been reported to occur commonly during arthroscopic surgery, which is frequently performed as an orthopedic surgical procedure. We here report a patient who experienced unilateral postoperative visual loss after a hip arthroscopy using irrigation fluid in the supine position without any evidence of external compression to either eye throughout the surgical procedure. Retinal fundoscopy suggested that the patient had central retinal artery occlusion, one of the causes of the postoperative visual loss. This case suggests that arthroscopic surgery may pose a substantial risk for paradoxical air embolism, such as central retinal artery occlusion, and suggests the need to prevent the entry of micro-air bubbles during such a type of surgery.
Subject(s)
Humans , Arthroscopy , Embolism, Air , Hip , Orthopedic Procedures , Postoperative Period , Retinal Artery Occlusion , Retinaldehyde , Supine PositionABSTRACT
Objective To investigate the clinical features of VAE and to assess the predictive value of VAE cough. Methods We retrospectively reviewed the medical records of 461 consecutive patients who underwent DBS surgery at Beijing Tiantan Hospital. Patients with VAE manifestation were enrolled in this study. The clinical features, operative courses, post-operative conditions and treatment of these patients were analyzed. The correlation between intraoperative tremor intensity , cough duration and prognosis was also investigated. Results Among 461 patients,10 (2.2%) were found with evidence of VAE, including cough, dyspnea, decreased O2 saturation (SO2). Statistical analyses revealed that severe cough was associated with greater age , a longer coughing time, more intensive tremor, greater influence, and a longer length of stay (P < 0.05, rspectively). Conclusions Early recognition and prompt management of VAE are essential to prevent unfavorable consequences. Cough intensity might be a useful tool for evaluating VAE and its prognosis , which is helpful for neurosurgeons to decide on the subsequent maneuvers.
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Cerebral arterial air embolism (CAAE), although infrequent, is a complication that can occur at any time during an invasive medical procedure. We experienced two cases of CAAE during cerebral angiography accidentally. The author reports the two cases of CAAE wherein air emboli dissolved spontaneously and immediately under normal atmospheric pressure, not under therapeutic hyperbaric environment. One of the cases shows entire dissolution of the air embolus on the moving image. This report shows that arterial air embolus can be absorbed spontaneously, and air embolus size is one of the factors that influence air embolus dissolution besides hyperbaric oxygen condition.
Subject(s)
Absorption , Atmospheric Pressure , Cerebral Angiography , Embolism , Embolism, Air , OxygenABSTRACT
Cerebral air embolism is a rare but potentially life-threatening complication. We experienced a living-donor liver transplant recipient who presented with unexpected cerebral air embolism and transient neurologic abnormalities that subsequently developed just after the removal of the pulmonary artery catheter from the central venous access device. One day after the initial event, the patient's neurologic status gradually improved. The patient was discharged 30 days after liver transplantation without neurologic sequelae.