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Journal of Spinal Disorders Mar 1990We present two cases of fatal venous air embolism that occurred in previously healthy adolescents during posterior spine fusion and instrumentation for scoliosis.... (Review)
Review
We present two cases of fatal venous air embolism that occurred in previously healthy adolescents during posterior spine fusion and instrumentation for scoliosis. Previously recorded cases in the literature have been rare and only briefly discussed. Air embolism has been a complication noted in the anesthesia and neurosurgical literature, occurring primarily in total hip patients and those patients undergoing neurosurgical procedures in a sitting position. An examination of the pathophysiology of air embolism in posterior spinal procedures would indicate the use of properly placed central lines and end-expiratory CO2 monitoring as the primary modes of detection and treatment considering the potentially fatal risk factors for spinal patients.
Topics: Adolescent; Animals; Dogs; Embolism, Air; Female; Heart Arrest; Humans; Hypotension; Incidence; Intraoperative Complications; Male; Multiple Organ Failure; Scoliosis; Spinal Fusion
PubMed: 2134405
DOI: No ID Found -
Digestive Endoscopy : Official Journal... Jul 2023
Topics: Humans; Embolism, Air; Stents
PubMed: 37218121
DOI: 10.1111/den.14601 -
The New England Journal of Medicine Mar 2022
Review
Topics: Decompression Sickness; Embolism, Air; Humans
PubMed: 35353963
DOI: 10.1056/NEJMra2116554 -
Journal of Medical Imaging and... Apr 2022Venous air embolization (VAE) from IV lines is a risk with IV contrast administration. The incidence of VAE ranges from 7% to 23%. While life-threatening VAE is rare,...
INTRODUCTION
Venous air embolization (VAE) from IV lines is a risk with IV contrast administration. The incidence of VAE ranges from 7% to 23%. While life-threatening VAE is rare, there is the potential risk of serious cerebrovascular events from paradoxical systemic air embolization (SAE) in patients with congenital intracardiac shunts. CT coronary angiogram (CTCA) hypothetically carries a higher risk of VAE as it requires dual injections as compared to single bolus dose contrast used in CT chest (CTC). The aim of this study was to assess the risk of VAE using CTCA as compared to conventional CTC. The incidence of cardiac shunts and their association with paradoxical SAE were also investigated.
METHODS
A retrospective study was conducted at a tertiary hospital. Adult patients undergoing CTCA and CTC over a 6-month period in 2017 were included. Images were reviewed on PACS for the presence of VAE. Electronic medical records were interrogated for evidence of neurological sequelae or requiring neurological imaging (CTB/MRIB) within 1 month of the initial imaging.
RESULTS
508 patients were included, 408 underwent CTCA and 100 underwent CTC. The VAE incidence in CTCA was 24% (94 patients) and 10% in the CTC (10 patients). This was statistically significant. Among the CTCA group, 36% (108 patients) had an intracardiac shunt. No statistically significant difference in VAE incidence was identified in CTCA patients with shunts vs without shunts. There was no incidence of SAE in both groups.
CONCLUSION
VAE is more common with CTCA than conventional CTC. There were no cases of paradoxical SAE found.
Topics: Adult; Computed Tomography Angiography; Coronary Angiography; Embolism, Air; Humans; Incidence; Retrospective Studies
PubMed: 34415110
DOI: 10.1111/1754-9485.13316 -
British Journal of Nursing (Mark Allen...The insertion and maintenance of advanced vascular access devices is increasingly becoming the remit of advanced nurses. Understanding the potential for air embolism as... (Review)
Review
The insertion and maintenance of advanced vascular access devices is increasingly becoming the remit of advanced nurses. Understanding the potential for air embolism as a complication of this procedure, recognising and managing the signs and symptoms, and being able to apply preventative measures, are imperative to enhance patient safety. A range of outcomes can present from air embolism depending on the rate and volume of air entrained, from sub-clinical to death, so the application of expert knowledge and vigilance is essential to minimise risk. According the the available literature, supplemental oxygen administration appears to be the most effective treatment.
Topics: Advanced Practice Nursing; Catheterization, Central Venous; Embolism, Air; Humans; Oxygen Inhalation Therapy
PubMed: 25158360
DOI: 10.12968/bjon.2014.23.sup14.s4 -
Clinical Journal of the American... Feb 2017Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs... (Review)
Review
Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.
Topics: Azotemia; Embolism, Air; Emergencies; Equipment Failure; Hemolysis; Hemorrhage; Humans; Hypersensitivity; Needles; Renal Dialysis; Root Cause Analysis; Water Supply
PubMed: 27831511
DOI: 10.2215/CJN.05260516 -
Neurocritical Care Feb 2023Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may... (Review)
Review
BACKGROUND
Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may be treated with hyperbaric oxygen therapy. We review the causes, radiographic and clinical characteristics, and outcomes of patients with CAE.
METHODS
We performed a retrospective chart review via an existing institutional database at Mayo Clinic to identify patients with arterial CAE. Demographic data, clinical characteristics, and diagnostic studies were extracted and classified on predefined criteria of diagnostic confidence, and descriptive and univariate analysis was completed.
RESULTS
Fifteen patients met criteria for inclusion in our study. Most presented with focal deficits (80%) and/or coma (53%). Seven patients (47%) had seizures, including status epilepticus in one (7%). Five presented with increased muscle tone at the time of the event (33%). Computed tomography (CT) imaging was insensitive for the detection of CAE, only identifying free air in 4 of 13 who underwent this study. When obtained, magnetic resonance imaging typically showed multifocal areas of restricted diffusion. Six patients (40%) were treated with hyperbaric oxygen therapy. Age, Glasgow Coma Scale score at nadir, and use of hyperbaric oxygen therapy were not associated with functional outcome at 1 year in our cohort. Twenty-six percent of patients had a modified Rankin scale score of 0 one year after the event, and functional improvement over time was common after discharge.
CONCLUSIONS
A high index of clinical suspicion is needed to identify patients with CAE because of low sensitivity of free air on CT imaging and nonspecific clinical presentation. Acute alteration of consciousness, seizures, and focal signs occur frequently. Because improvement over time is possible even among patients with severe presentation, early prognostication should be approached with caution.
Topics: Humans; Coma; Embolism, Air; Retrospective Studies; Tomography, X-Ray Computed; Seizures; Hyperbaric Oxygenation
PubMed: 36627433
DOI: 10.1007/s12028-022-01664-3 -
Internal Medicine (Tokyo, Japan) May 2023
Topics: Humans; Embolism, Air; Biopsy; Biopsy, Needle; Lung; Electrocardiography
PubMed: 36198592
DOI: 10.2169/internalmedicine.0292-22 -
Journal of Minimally Invasive Gynecology 2008Hysteroscopic surgery has gained in popularity and has become the method of choice for diagnostic and therapeutic interventions of intrauterine pathology. Advantages... (Review)
Review
Hysteroscopic surgery has gained in popularity and has become the method of choice for diagnostic and therapeutic interventions of intrauterine pathology. Advantages consist of short operating time, rapid postoperative recovery, and low morbidity. However, there are concerns about the potential serious complications that can occur, such as venous air and gas embolism. These are rare but hazardous complications, which can occur in all surgical procedures. In hysteroscopic surgery, large uterine veins may be exposed and are, therefore, a point of entry for gas or air. A number of fatal and nonfatal cases have been described as case reports. Although awareness for air and gas embolism is raised this way, proper guidelines as to how to reduce the risk of venous gas or air embolism are lacking. The pathophysiologic difference between gas and air embolism is described herein because composition of the gases differs as does their physiologic effects. A gas embolism is likely to be derived from electrosurgical vapors whereas air embolism seems to arise from improper purging of lines or reinsertion of hysteroscopic instruments. Treatment regimens must, therefore, be designed to address the specific gases involved. Signs and symptoms of these different embolisms are described, as early detection and intervention are crucial for survival. Furthermore, we provide guidelines for operating department personnel, surgeons, and anesthesiologists to reduce the risk of venous gas or air embolism during hysteroscopic procedures. Potential complications of these procedures may be prevented this way.
Topics: Ambulatory Surgical Procedures; Carbon Dioxide; Embolism, Air; Female; Humans; Hysteroscopy; Monitoring, Physiologic; Operating Rooms; Postoperative Complications; Uterus
PubMed: 18313001
DOI: 10.1016/j.jmig.2007.10.010 -
Der Anaesthesist May 2021The entry of gases into the vascular system is called vascular air embolism (VAE). The blocking of the pulmonary circulation by VAE can lead to fulminant right-sided... (Review)
Review
The entry of gases into the vascular system is called vascular air embolism (VAE). The blocking of the pulmonary circulation by VAE can lead to fulminant right-sided heart failure and cardiocirculatory arrest. A VAE can occur at any time if there is an open connection between the environment and a venous vessel with subatmospheric pressure. This situation occurs during ear nose throat surgery, hip surgery, surgery of the lesser pelvis or breast surgery, if the surgical field is above the level of the heart; however, a VAE can also occur during routine tasks, such as insertion or removal of a central venous catheter or during endoscopic procedures with the insufflation of gas.Because during these procedures VAE is not the main focus of the anesthesia or surgery personnel, in such situations its sudden unexpected occurrence can have severe consequences. In contrast, in cardiac surgery or neurosurgery the risk of intraoperative VAE is much better known. In procedures with a higher risk of a clinically relevant VAE, a patent foramen ovale should be ruled out by preoperative transesophageal echocardiography (TEE). Intraoperatively TEE is the most sensitive procedure not only to detect a VAE but also to visualize the clinical expression, e.g. acute right heart overload.The avoidance of an initial and repeated air embolism is the primary measure to minimize the incidence and severity of VAE.Intraoperatively the following measures should be undertaken: excellent communication between anesthesia and surgery personnel with predetermined actions, maintenance of normal volume, patient positioning with minimal difference in height between heart and head, state of the art surgical technique with closure of potential air entry sites, sufficient detection of air by TEE, repeated jugular vein compression during neurosurgery, intraoperative Trendelenburg positioning of the patient during persisting or clinically evident VAE, differentiated adjustment of ventilatory settings and catecholamine treatment, aspiration of the blood-air mixture (air lock) at the junction of the superior vena cava and right atrium through a large bore central venous line and keeping check of the coagulation status.
Topics: Echocardiography, Transesophageal; Embolism, Air; Humans; Neurosurgical Procedures; Patient Positioning; Vena Cava, Superior
PubMed: 33196882
DOI: 10.1007/s00101-020-00894-4