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Medicine Jun 2021Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the...
INTRODUCTION
Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism.
PATIENT CONCERNS
We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers.
DIAGNOSES
Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made.
INTERVENTIONS
The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation.
OUTCOMES
Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities.
CONCLUSIONS
While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.
Topics: Adult; Early Medical Intervention; Echocardiography, Transesophageal; Embolism, Air; Endoscopy; Female; Heart; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Patient Care Management; Pulmonary Artery; Risk Assessment; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 34115039
DOI: 10.1097/MD.0000000000026304 -
The New England Journal of Medicine Jun 2000
Topics: Animals; Dogs; Embolism, Air; Head-Down Tilt; Hemodynamics; Humans
PubMed: 10877658
DOI: 10.1056/NEJM200006293422617 -
BMJ Case Reports Dec 2016Air embolism is often an iatrogenic complication which may occur in venous or arterial circulation depending on the port of entry. We present two cases in which air...
Air embolism is often an iatrogenic complication which may occur in venous or arterial circulation depending on the port of entry. We present two cases in which air embolism occurred in venous and arterial circulation after contrast medium injection (CMI) and coronary artery bypass graft (CABG) surgery, respectively. In one case, accumulation of air bubbles was observed in the pulmonary artery after CMI. This was attributed to inadvertent injection of air owing to improper connection of the injector and the catheter. The patient was managed with 100% oxygen in the Trendelenburg and left lateral decubitus position. Repeat imaging demonstrated resorption of the emboli. In another case, air was introduced during CABG in the left atrium and ventricle. Immediate suction of air was attempted however, the patient developed cardiogenic shock requiring vasopressors, and subsequently seizures and coma due to diffuse ischaemic stroke. The patient eventually expired.
Topics: Aged; Aged, 80 and over; Catheterization, Central Venous; Contrast Media; Coronary Artery Bypass; Embolism, Air; Female; Glucocorticoids; Humans; Infusions, Intravenous; Male; Treatment Outcome
PubMed: 27920021
DOI: 10.1136/bcr-2016-217550 -
Journal of Medical Case Reports Feb 2024Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for...
BACKGROUND
Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting.
CASE PRESENTATION
This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week.
CONCLUSIONS
This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.
Topics: Humans; Female; Middle Aged; Embolism, Air; Liver Transplantation; Thrombosis; Heart Diseases; Echocardiography, Transesophageal; Intraoperative Complications; Liver Neoplasms; Pulmonary Embolism
PubMed: 38368412
DOI: 10.1186/s13256-024-04376-8 -
CMAJ : Canadian Medical Association... Aug 2017
Topics: Contrast Media; Diagnosis, Differential; Embolism, Air; Female; Humans; Injections, Intravenous; Middle Aged; Pulmonary Embolism; Tomography, X-Ray Computed
PubMed: 28827438
DOI: 10.1503/cmaj.170265 -
Anesthesiology Nov 2017
Review
Topics: Anesthesia; Cardiac Catheterization; Child; Embolism, Air; Humans; Point-of-Care Systems; Ultrasonography
PubMed: 28562374
DOI: 10.1097/ALN.0000000000001712 -
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 -
AJNR. American Journal of Neuroradiology 2014Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1... (Review)
Review
Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1 and 2, depending on the clinical presentation. MR imaging is currently the most accurate neuroimaging technique available for the detection of brain and spinal cord lesions in neurologic type 2 decompression sickness. Rapid bubble formation in tissues and the bloodstream during ascent is the basic pathophysiologic mechanism in decompression illness. These bubbles can damage the central nervous system through different mechanisms, namely arterial occlusion, venous obstruction, or in situ toxicity. Neuroimaging studies of decompression sickness have reported findings associated with each of these mechanisms: some typical results are summarized and illustrated in this article. We also review the limitations of previous work and make practical methodologic suggestions for future neuroimaging studies.
Topics: Brain Diseases; Decompression Sickness; Diving; Embolism, Air; Humans; Neuroimaging; Spinal Cord Diseases
PubMed: 24924550
DOI: 10.3174/ajnr.A4005 -
Anaesthesia Jan 2017
Topics: Embolism, Air; Guidelines as Topic; Humans; Hyperbaric Oxygenation; Intracranial Embolism; Intraoperative Complications; Vascular Access Devices
PubMed: 27988963
DOI: 10.1111/anae.13759 -
Journal of Clinical Anesthesia May 1997Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is... (Review)
Review
Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is forced under pressure into a body cavity. Though classically associated with neurosurgery, VAE is also a potential complication of laparoscopic, pelvic, and orthopedic procedures. It is, therefore, essential for the practicing anesthesiologist to recognize and treat venous air entrainment. An in-depth review of the pathophysiology, clinical presentation, detection, prevention, and treatment of VAE is presented.
Topics: Embolism, Air; Humans; Intraoperative Complications
PubMed: 9172037
DOI: 10.1016/s0952-8180(97)00024-x