scholarly journals Acute pulmonary edema due to occult air embolism detected on an automated anesthesia record: illustrative case

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Samuel Wood ◽  
Gennadiy Fuzaylov
Keyword(s):  
Pulmonary Edema ◽  
Rare Complication ◽  
Air Embolism ◽  
Acute Pulmonary Edema ◽  
Illustrative Case ◽  
Event Analysis ◽  
Venous Air Embolism ◽  
Postoperative Ventilation ◽  
End Tidal ◽  
Record Review

BACKGROUNDThe authors report a case of venous air embolism (VAE) during a pediatric posterior fossa craniotomy with resulting pulmonary edema requiring postoperative ventilation. Pulmonary edema is a known but rare complication of VAE, and diagnosis and treatment are discussed.OBSERVATIONSThe embolism was undetected during the surgical procedure, and the first clinical sign of respiratory decompensation appeared an hour after the initial insult, with imaging suggesting acute pulmonary edema. A transient but significant end-tidal carbon dioxide decrease was detected on postoperative review of the anesthesiology record.LESSONSThis report highlights an uncommon sequela of VAE and the importance of post hoc automated record review for intraoperative event analysis.

Acute pulmonary edema following venous air embolism during a neurosurgical procedure

1974 ◽  
Vol 40 (3) ◽  
pp. 400-404 ◽  
Author(s):  
William F. Chandler ◽  
Donald G. Dimcheff ◽  
James A. Taren
Keyword(s):  
Pulmonary Edema ◽  
Air Embolism ◽  
Acute Pulmonary Edema ◽  
Sitting Position ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Venous Air Embolism ◽  
Cause And Effect ◽  
Possible Cause ◽  
Fine Print

✓ A case of venous air embolism during a procedure in the sitting position is reported in which the patient developed fulminant pulmonary edema within 2 hours of the embolus. Possible cause and effect relationships are discussed.

scholarly journals Not fatal venous air embolism after holmium laser enucleation of the prostate: Case report and review of literature

2020 ◽  
Vol 92 (1) ◽  
pp. 55-57
Author(s):  
Daniele Romagnoli ◽  
Mobin Ghaemian ◽  
Daniele D'Agostino ◽  
Paolo Corsi ◽  
Marco Giampaoli ◽  
...  
Keyword(s):  
Rare Complication ◽  
Air Embolism ◽  
Holmium Laser ◽  
Oxygen Saturation Level ◽  
Venous Air Embolism ◽  
Arterial Blood ◽  
Urinary Tract Symptoms ◽  
Laser Enucleation ◽  
End Tidal ◽  
Holmium Laser Enucleation

Objective: Holmium laser has demonstrated high efficacy in urethral disobstruction. Venous air embolism (VAE) is a rare complication of prostate surgery. Only two cases of venous air embolism (VAE) in patients submitted to HoLEP, have been described. In this paper we show a third case of not fatal VAE after HoLEP. Materials and methods: A case of VAE occurred in holmium laser enucleation (HoLEP) due to obstructive lower urinary tract symptoms (LUTS) in a 70 years old patient. After the procedure, patient’s end tidal carbon dioxide (ETCO2) levels dramatically decreased at 17 mmHg, with pressure airway (PAW)16 mmHg; oxygen saturation level was at 75%, without any loss in the ventilation circuit and with arterial blood pressure of 94/54 mmHg. Due to the negativity for other suspicions, the suspect of VAE was postulated. Result: The immediate switching from laryngeal mask to Oro Tracheal Intubation increased the oxygen level. A cardiac transthoracic ultrasound was negative for air bubbles inside cardiac cavities, without any alteration in the cardiac kinetics. Arterial blood sample turned negative for any alteration compatible with VAE and catheter continuous vesical irrigation was started to obtain clear washing fluid without blood cloths. The extubated patient showed no neurological defects. Conclusions: An invasive monitoring system is the key to rapidly and correctly identify any embolic episode during this kind of surgery.

Venous Air Embolism, A Possible Cause of Acute Pulmonary Edema

1976 ◽  
Vol 45 (4) ◽  
pp. 453-455 ◽  
Author(s):  
BADR A. ISHAK ◽  
FRANK L. SELENY ◽  
ZEHAVA L. NOAH
Keyword(s):  
Pulmonary Edema ◽  
Air Embolism ◽  
Acute Pulmonary Edema ◽  
Venous Air Embolism ◽  
Possible Cause

Acute pulmonary edema after low-level air embolism during craniotomy

1996 ◽  
Vol 85 (5) ◽  
pp. 937-940 ◽  
Author(s):  
David M. Frim ◽  
Lisa Wollman ◽  
Allison B. Evans ◽  
Robert G. Ojemann
Keyword(s):  
Pulmonary Edema ◽  
Air Embolism ◽  
Hemodynamic Instability ◽  
Acute Pulmonary Edema ◽  
Content Type ◽  
Low Level ◽  
Fraction Of Inspired Oxygen ◽  
End Tidal ◽  
Air Embolus ◽  
Inspired Oxygen

✓ Acute pulmonary edema after a large air embolus occurring during neurosurgery is a recognized phenomenon. The authors describe the course of a 76-year-old man who presented with noncardiogenic pulmonary edema shortly after undergoing resection of a high convexity meningioma. Transthoracic Doppler sonography, however, showed no evidence of a large intraoperative emboli; the evidence for ongoing but low-magnitude air embolus included visualization of bone aspiration of irrigant before bone-edge waxing, transient intraoperative declines in end-tidal CO2 tension, and an increase of the fraction of inspired oxygen to maintain adequate saturation after removal of the craniotomy flap. There was no hemodynamic instability noted. The airspace disease was self-limited and resolved on supportive treatment after approximately 1 week, as would be expected for pulmonary edema caused by a single large intravenous air embolus. The authors present this case as the first report of pulmonary edema resulting from low-level air embolus occurring during craniotomy. This situation may go unrecognized intraoperatively but can cause the same significant postoperative morbidity as larger, more easily identified air emboli.

scholarly journals Hypoxaemia following Sustained Low-Volume Venous Air Embolism in Sheep

1988 ◽  
Vol 16 (2) ◽  
pp. 164-170 ◽  
Author(s):  
J. Pfitzner ◽  
S. P. Petito ◽  
A. G. McLean
Keyword(s):  
Arterial Oxygen Saturation ◽  
Air Embolism ◽  
Arterial Oxygen ◽  
Venous Air Embolism ◽  
Minute Period ◽  
Volume Ventilation ◽  
Gas Measurements ◽  
Respiratory Disturbance ◽  
Upright Head ◽  
End Tidal

In six upright (head above thorax) anaesthetised sheep, serial blood gas measurements were made over a 100-minute period during which repeated small-volume air emboli were injected intravenously to lower and maintain the end-tidal CO 2 concentration approximately 0.5% below its initial baseline level. With constant volume ventilation and an inspired N 2 O:O 2 ratio of 2:1, the arterial PCO 2 progressively increased and the arterial PO 2 progressively decreased with significant arterial hypoxaemia ensuing in three out of the six animals. It is suggested that during neurosurgery performed in the sitting position and with an inspired oxygen concentration of 33%, the degree of cardio-respiratory disturbance caused by venous air embolism should be assessed by continuous monitoring not only of end-tidal CO 2 concentration but also of arterial oxygen saturation using pulse oximetry.

Venous Air Embolism, Hypotension, and End-Tidal Nitrogen

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Jane M. Matjasko ◽  
Jeffrey Hellman ◽  
Colin F. Mackenzie
Keyword(s):  
Air Embolism ◽  
Venous Air Embolism ◽  
End Tidal

Venous Air Embolism during Endoscopic Strip Craniectomy for Repair of Craniosynostosis in Infants

2001 ◽  
Vol 95 (2) ◽  
pp. 340-342 ◽  
Author(s):  
Joseph D. Tobias ◽  
Joel O. Johnson ◽  
David F. Jimenez ◽  
Constance M. Barone ◽  
D. Scott McBride
Keyword(s):  
Surgical Procedures ◽  
Operating Time ◽  
Air Embolism ◽  
Postoperative Recovery ◽  
Surgical Time ◽  
Venous Air Embolism ◽  
Low Incidence ◽  
End Tidal ◽  
Neonates And Infants ◽  
Strip Craniectomy

Background Various studies have reported an incidence of venous air embolism (VAE) as high as 82.6% during surgical procedures for craniosynostosis. There has been an increase in the use of minimally invasive, endoseopie surgical procedures, including applications for endoscopic strip craniectomy. The current study prospectively evaluated the incidence of VAF during endoscopic strip craniectomy. Methods Continuous, intraoperative monitoring for VAE was performed using precordial Doppler monitoring. A recording was made of the Doppler tones and later reviewed to verify its accuracy. Results The cohort for the study included 50 consecutive neonates and infants ranging in age from 3.5 to 36 weeks and ranging in weight from 3 to 9 kg. Surgical time varied from 31 to 95 min for a total of 2,701 mm of operating time, during which precordial Doppler tones were auscultated. In 46 patients, there was no evidence of VAE. In four patients, there was a single episode of VAE. Two of the episodes of VAE were grade I (change in Doppler tones), and two were grade H (change in Doppler tones and decrease in end-tidal carbon dioxide). No grade III (decrease in systolic blood pressure by 20% from baseline) VAF was noted. Conclusion In addition to previously reported benefits of decreased blood loss, decreased surgical time, and improved postoperative recovery time, the authors noted a low incidence of VAF during endoscopic strip craniectomy in neonates and infants.

Sensitivity of End-tidal Nitrogen in Venous Air Embolism Detection in Dogs

1985 ◽  
Vol 63 (4) ◽  
pp. 418-423 ◽  
Author(s):  
J. Matjasko ◽  
P. Petrozza ◽  
C. F. Mackenzie
Keyword(s):  
Air Embolism ◽  
Venous Air Embolism ◽  
End Tidal
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