-
Journal of Laparoendoscopic & Advanced... Dec 2022Air embolism during laparoscopic surgery is a rare but feared complication in the pediatric population. The objective of this study was to identify rates of air embolus...
Air embolism during laparoscopic surgery is a rare but feared complication in the pediatric population. The objective of this study was to identify rates of air embolus in pediatric patients during hospitalization for laparoscopic or open surgical procedures of the peritoneal cavity. Patients 0-18 years old within the Pediatric Health Information System who underwent a predefined, common inpatient laparoscopic or open surgical procedure involving the peritoneal cavity from 2015 to 2020 were studied. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for air embolism were then searched among patients during the same admission. Firth logistic regression was used to compare rates of air embolism in open and laparoscopic cohorts and in patients >1 and ≤1 year. Unadjusted rates of air embolism were higher in patients undergoing open compared with laparoscopic surgery (open: 9/45,080; 20.0/100,000 patients versus laparoscopic: 3/101,892; 2.9/100,000 patients). In patients ≤1 year (45,726), 2 patients undergoing open surgery (2/1,031; 9.5/100,000 patients) and all 3 patients undergoing laparoscopic surgery had an air embolism diagnosis (3/22,329; 13.4/100,000 patients). For laparoscopic surgery, a suggested lower relative risk (RR) of air embolism was demonstrated for children >1 year compared with children ≤1 year (RR: 0.05, = .05). Air embolism associated with common pediatric surgical procedures of the peritoneum is rare and patients undergoing laparoscopic and open surgery have similar risks for air embolism. Although rare, the risk should be considered during surgical planning and abdominal access, especially in children ≤1 year old.
Topics: Child; Humans; Infant, Newborn; Infant; Child, Preschool; Adolescent; Embolism, Air; Peritoneum; Laparoscopy; Peritoneal Cavity; Retrospective Studies
PubMed: 36318787
DOI: 10.1089/lap.2022.0246 -
The American Journal of Case Reports Oct 2020BACKGROUND Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral...
BACKGROUND Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral air embolism are nonspecific and may be attributed to sedation-related complications and central nervous system insults. Having awareness of this rare iatrogenic event and deciding on immediate imaging when it is suspected are essential for prompt diagnosis and treatment. CASE REPORT A 72-year-old man with a past medical history of alcoholic liver cirrhosis with associated portal hypertension underwent an outpatient esophago-gastroduodenoscopy for surveillance of esophageal varices. During the procedure, the patient retched several times and developed a mucosal tear, which was repaired using endoscopic clips. After the procedure, the patient remained sedated for a prolonged time and was subsequently unresponsive. Nonenhanced CT of the head showed several foci of gas throughout the subarachnoid spaces. Follow-up nonenhanced brain magnetic resonance imaging demonstrated ischemic changes, which were more prominent along the right cerebral hemisphere. CONCLUSIONS Cerebral air embolism is an iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. It must be included in the differential diagnosis of a patient presenting with altered mental status and neurological deficits after an endoscopic procedure. Diagnostic imaging can be useful in identifying key features of this iatrogenic event. Timely diagnosis and treatment can improve patient outcomes.
Topics: Aged; Brain; Embolism, Air; Humans; Iatrogenic Disease; Magnetic Resonance Imaging; Male
PubMed: 33090976
DOI: 10.12659/AJCR.925046 -
La Revue de Medecine Interne Mar 2020
Topics: Chemical and Drug Induced Liver Injury; Diagnosis, Differential; Embolism, Air; Female; Hair Dyes; Humans; Hydrogen Peroxide; Hyperbaric Oxygenation; Liver; Occupational Diseases; Occupational Exposure; Young Adult
PubMed: 31153650
DOI: 10.1016/j.revmed.2019.05.008 -
British Journal of Anaesthesia Jun 2015Neurosurgical procedures requiring a sitting position may put the patient at risk of a potentially life-threatening air embolism. Transient manual jugular venous...
BACKGROUND
Neurosurgical procedures requiring a sitting position may put the patient at risk of a potentially life-threatening air embolism. Transient manual jugular venous compression limits further air entry in this situation. This study presents an alternative technique aimed at reducing the risk of air embolism.
METHODS
In an in vitro model, an intrajugular balloon catheter was inserted to demonstrate that this device prevents air embolism. In an in vivo study, this device was bilaterally placed into jugular vessels in pigs. Using an ultrasound technique, blood flow was monitored and jugular venous pressure was recorded before and during cuff inflation. Air was applied proximally to the inflated cuffs to test the hypothesis that this novel device blocks air passage.
RESULTS
In vitro, the intrajugular balloon catheter reliably prevented further air entry (n=10). Additionally, accumulated air could be aspirated from an orifice of the catheter (n=10). In vivo, inflation of the catheter balloon completely obstructed venous blood flow (n=8). Bilateral inflation of the cuff significantly increased the proximal jugular venous pressure from 9.8 (2.4) mm Hg to 14.5 (2.5) mm Hg (n=8, P<0.05). Under conditions mimicking an air embolism, air passage across the inflated cuffs was prevented and 78 (20%) (n=6) of the air dose could be aspirated by the proximal orifice of the catheter.
CONCLUSIONS
These findings may serve as a starting point for the development of intrajugular balloon catheters designed to reduce the risk of air embolism in patients undergoing neurosurgery in a sitting position.
Topics: Animals; Balloon Occlusion; Catheterization, Peripheral; Embolism, Air; Jugular Veins; Neurosurgical Procedures; Patient Positioning; Swine; Ultrasonography
PubMed: 25835025
DOI: 10.1093/bja/aev040 -
The British Journal of Radiology Oct 2023To investigate the incidence of air embolism (AE) related to CT-guided localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic...
OBJECTIVE
To investigate the incidence of air embolism (AE) related to CT-guided localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS).
METHODS
The data of all patients who received CT-guided localization of GGNs before VATS from May 2020 to October 2021 were retrospectively analyzed.
RESULTS
A total of 1395 consecutive patients with 1553 GGNs were enrolled. AEs occurred in seven patients (0.5%). In four of the seven patients with AE, the embolism was detected before the patients left the CT table and emergency treatments were carried out. Among them, one patient had chest tightness and unilateral limb dyskinesia, one patient had convulsions and transient loss of consciousness, and two patients had no definite clinical symptoms. After a short-term high-flow oxygen inhalation, the clinical symptoms of two patients with symptomatic AE disappeared and two patients with asymptomatic AE did not show any symptoms. In the remaining three patients with AE, the embolism were detected retrospectively when evaluating the images in the PACS for this study. Fortunately, these three patients never developed clinical symptoms related to AE. All seven patients with AE underwent VATS on the day of localization and all GGNs were successfully removed under the guidance of markers.
CONCLUSION
The incidence of AE related to CT-guided localization of GGNs was 0.5%, which was significantly higher than expected. Post-localization whole thoracic CT should be performed and observed carefully so as to avoid missed AE and delayed treatment.
ADVANCES IN KNOWLEDGE
The incidence of AE related to CT-guided localization of GGNs was 0.5%. In order to timely detect AE, whole thoracic CT scan rather than local CT in the lesion area should be performed after localization. A small amount of AE may be missed if the post- localization CT images are not carefully observed.
Topics: Humans; Lung Neoplasms; Embolism, Air; Retrospective Studies; Solitary Pulmonary Nodule; Multiple Pulmonary Nodules; Tomography, X-Ray Computed
PubMed: 37660366
DOI: 10.1259/bjr.20220583 -
Journal of Clinical Anesthesia Feb 2017Digestive endoscopic procedures have become increasingly common diagnostic and therapeutic procedures in hospitals. Generally they are safe procedures and complications,...
Digestive endoscopic procedures have become increasingly common diagnostic and therapeutic procedures in hospitals. Generally they are safe procedures and complications, though infrequent, can occur and are potentially lethal. As the number of procedures performed increases, the complications arising are likely to become more frequent, so it is advisable to bear this in mind when establishing early diagnosis and treatment. Cerebral air embolism is a rare complication after a digestive endoscopic procedure, although in the case of endoscopic retrograde cholangiopancreatography (ERCP), may be as high as 10%. In such cases there are usually local circumstances exist favoring the entry of air into the bloodstream, and in some cases it is the presence of a patent foramen ovale that favors the passage of air into the arterial system. The clinical signs and symptoms will depend on the speed and volume of the air infused and on the territory affected, and in some cases the consequences may be fatal.
Topics: Aged, 80 and over; Bile Duct Neoplasms; Cholangiocarcinoma; Cholangiopancreatography, Endoscopic Retrograde; Embolism, Air; Fatal Outcome; Humans; Intracranial Embolism; Male; Stroke; Tomography, X-Ray Computed
PubMed: 28183551
DOI: 10.1016/j.jclinane.2016.10.029 -
JACC. Cardiovascular Interventions Mar 2024
Topics: Humans; Embolism, Air; Mydriasis; Treatment Outcome; Tomography, X-Ray Computed
PubMed: 38244006
DOI: 10.1016/j.jcin.2023.12.026 -
Artificial Organs Sep 2021Although de-airing procedures are commonly performed during cardiac surgery, use of these procedures is not necessarily based on evidence. Uncertainly remains around the...
Although de-airing procedures are commonly performed during cardiac surgery, use of these procedures is not necessarily based on evidence. Uncertainly remains around the size of bubbles that can be detected by echocardiography, whether embolized air or carbon dioxide can be absorbed, and the reasons for embolic events occurring despite extensive de-airing. Since air bubbles are invisible in the blood, we used simple experimental models employing water and 10% dextran solution to determine the correlation between actual bubble size and the depicted size on echocardiography, bubble size, and floatation velocity and the absorption of carbon dioxide under embolization and irrigation conditions. Bubbles depicted as larger than 1 mm were overestimated by echocardiography: the actual size was larger than 0.4 mm in diameter. While bubbles of 0.5 mm had a floatation velocity of 2 to 3 cm/s, the buoyancy of bubbles smaller than 0.3 mm was negligible. Thus, bubbles that are depicted as larger than 1 mm on echocardiography or that present with apparent buoyancy should be visible and need to be meticulously removed. However, echocardiography cannot distinguish bubbles of around 0.1 mm in diameter from those of capillary size (<10 μm). Thus, we advise continuous venting of dense bubbles until they become sparse. While carbon dioxide was rapidly absorbed when circulating, the absorption of embolized carbon dioxide was negligible. These results suggest that detected intracardiac air represents residual "air," with carbon dioxide already absorbed. Therefore, the use of conventional de-airing procedures needs reconsideration: air and buoyant bubbles should be removed from the heart before they are expelled into the aorta; this requires timely and precise assessment with transesophageal echocardiography and effective collaboration between surgeons, anesthesiologists, and perfusionists.
Topics: Carbon Dioxide; Cardiac Surgical Procedures; Echocardiography, Transesophageal; Embolism, Air; Humans; In Vitro Techniques; Models, Cardiovascular
PubMed: 33908061
DOI: 10.1111/aor.13975 -
Tidsskrift For Den Norske Laegeforening... Jan 2019
Topics: Aged; Brachiocephalic Veins; Embolism, Air; Female; Humans; Patient Positioning; Tomography, X-Ray Computed
PubMed: 30644669
DOI: 10.4045/tidsskr.18.0017 -
Current Vascular Pharmacology 2018Undersea diving is a sport and commercial industry. Knowledge of potential problems began with Caisson disease or "the bends", first identified with compressed air in... (Review)
Review
Undersea diving is a sport and commercial industry. Knowledge of potential problems began with Caisson disease or "the bends", first identified with compressed air in the construction of tunnels under rivers in the 19th century. Subsequently, there was the commercially used old-fashioned diving helmet attached to a suit, with compressed air pumped down from the surface. Breathhold diving, with no supplementary source of air or other breathing mixture, is also a sport as well as a commercial fishing tool in some parts of the world. There has been an evolution to self-contained underwater breathing apparatus (SCUBA) diving with major involvement as a recreational sport but also of major commercial importance. Knowledge of the physiology and cardiovascular plus other medical problems associated with the various forms of diving have evolved extensively. The major medical catastrophes of SCUBA diving are air embolism and decompression sickness (DCS). Understanding of the essential referral to a hyperbaric recompression chamber for these problems is critical, as well as immediate measures until that recompression is achieved. These include the administration of 100% oxygen and rehydration with intravenous normal saline. Undersea diving continues to expand, especially as a sport, and a basic understanding of the associated preventive and emergency medicine will decrease complications and save lives.
Topics: Breath Holding; Cardiovascular Diseases; Decompression Sickness; Diving; Early Diagnosis; Embolism, Air; Equipment Design; Fluid Therapy; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Hyperbaric Oxygenation; Infusions, Intravenous; Personal Protective Equipment; Predictive Value of Tests; Protective Clothing; Protective Factors; Respiratory Protective Devices; Risk Assessment; Risk Factors; Saline Solution; Treatment Outcome
PubMed: 28676021
DOI: 10.2174/1570161115666170621084316