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Anesthesiology Feb 2023
Topics: Humans; Embolism, Air; Anesthesia; Anesthesiology; Coronary Artery Disease
PubMed: 36441142
DOI: 10.1097/ALN.0000000000004413 -
Presse Medicale (Paris, France : 1983) Oct 1996The incidence of iatrogenic air embolism can only be estimated since many accidents are not recognized. Clinical manifestations, essentially neurological or... (Review)
Review
The incidence of iatrogenic air embolism can only be estimated since many accidents are not recognized. Clinical manifestations, essentially neurological or cardiovascular disorders vary greatly. Air embolism may occur during coronary or cerebral arteriography, cardiopulmonary bypass, venous catheterism, various types of surgery or blood transfusion among other situations. Once air has entered the arterial circulation, the bubble of gas follows the blood flow until it is blocked by a smaller calibre vessel. The progressive diffusion of the air reduces the size of the embolus which then migrates on to smaller and smaller vessels. Subsequent pathological manifestations of air embolism result from mechanical obstruction leading to ischemia and inflammatory reactions to air acting as a foreign body. The sudden onset signs of neurological impairment with or without a cardiopulmonary component in patients in a high-risk situation leads to clinical diagnosis. Treatment must be started immediately although brain CT scan or echocardiography may help confirm the diagnosis. The source of the air must be immediately identified and removed and the vital functions controlled. Mechanical or facial mask ventilation with pure oxygen is indicated. Hyperbaric oxygen therapy should be instituted. Morbidity and mortality after iatrogenic air embolism is high but major improvements have been achieved with oxygen therapy. Neurological sequellae have been estimated to reach 19 to 50% of the patients. A personal controlled prospective study revealed 14% mortality after hyperbaric oxygen therapy given within 12 hours of the accident.
Topics: Embolism, Air; Humans; Iatrogenic Disease; Oxygen Inhalation Therapy
PubMed: 8958877
DOI: No ID Found -
Journal of Clinical Anesthesia Feb 2021
Topics: Embolism, Air; Endoscopy; Humans; Ultrasonography
PubMed: 32987331
DOI: 10.1016/j.jclinane.2020.110067 -
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 -
Archives of Internal Medicine Nov 1982Venous air embolism causes injury primarily by obstruction of blood flow from the right side of the heart to the left. This is due to mechanical obstruction of the right...
Venous air embolism causes injury primarily by obstruction of blood flow from the right side of the heart to the left. This is due to mechanical obstruction of the right ventricular pulmonary outflow tract and pulmonary vasculature and to poorly understood pulmonary vasoconstrictive mechanisms. Venous air embolism can result in considerable hypoxemia from ventilation-perfusion maldistribution and shunt. With large emboli, systemic hypotension, myocardial ischemia, and arrhythmias can occur and result in death. One should be familiar with the clinical setting where embolism occurs, as prevention is the best treatment. When air embolism is suspected, placement of the patient in the left lateral decubitus position, initiating closed chest massage or, if possible, aspiration of air through a right atrial or Swan-Ganz catheter are all acceptable forms of treatment. The patient should also be given 100% oxygen.
Topics: Animals; Coronary Circulation; Dogs; Embolism, Air; Humans; Hypoxia; Injections, Intravenous; Posture; Pulmonary Circulation; Pulmonary Edema; Pulmonary Veins; Surgical Procedures, Operative; Vasoconstriction; Ventilation-Perfusion Ratio
PubMed: 7138162
DOI: No ID Found -
Diving and Hyperbaric Medicine Sep 2021Only a few clinical cases of cerebral arterial gas embolism during spinal surgery are published. It seems important not to overlook this diagnosis in order to initiate...
Only a few clinical cases of cerebral arterial gas embolism during spinal surgery are published. It seems important not to overlook this diagnosis in order to initiate rapid appropriate treatment. This was a suspected case of paradoxical gas embolism revealed postoperatively by neurological deficits and whose recovery was noted during hyperbaric oxygen treatment. Unfortunately, no complementary examination showed gas embolism and only the context, the clinical picture and the case evolution evoke this diagnosis. The diagnostic difficulty in the immediate postoperative period is highlighted.
Topics: Embolism, Air; Humans; Hyperbaric Oxygenation; Intracranial Embolism; Oxygen; Patient Positioning; Prone Position
PubMed: 34547783
DOI: 10.28920/dhm51.3.303-305 -
British Medical Journal Jul 1971Two fatal and five non-fatal episodes of air embolism occurred in the course of 14,000 haemodialyses. Air entered the circuit through the infusion bottle, the heparin...
Two fatal and five non-fatal episodes of air embolism occurred in the course of 14,000 haemodialyses. Air entered the circuit through the infusion bottle, the heparin syringe or line, or the blood pump insert. Emergency treatment with posture, oxygen, dextran infusion, and dexamethasone was apparently successful in reversing some of the manifestations. Prevention depends partly on better design of equipment and partly on the incorporation in the haemodialysis circuit of devices which detect air and prevent it from reaching the patient. Such monitors are not in general use in the United Kingdom and those currently available are far from infallible. We describe an alternative system incorporating a floating valve in the bubble trap.
Topics: Adult; Coronary Vessels; Dexamethasone; Embolism, Air; Female; Humans; Hypertension, Pulmonary; Male; Mesenteric Arteries; Middle Aged; Monitoring, Physiologic; Oxygen Inhalation Therapy; Posture; Pressure; Pulmonary Circulation; Renal Dialysis; Syringes
PubMed: 5090823
DOI: 10.1136/bmj.3.5766.74 -
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 -
American Journal of Respiratory and... May 2022
Topics: COVID-19; Embolism, Air; Extracorporeal Membrane Oxygenation; Humans; Pulmonary Embolism
PubMed: 35353653
DOI: 10.1164/rccm.202109-2181IM -
Tidsskrift For Den Norske Laegeforening... Feb 2021
Topics: Embolism, Air; Humans; Intracranial Embolism; Tomography, X-Ray Computed
PubMed: 33624980
DOI: 10.4045/tidsskr.20.0727