Gas Embolism

Development of Cerebral Air Emboli During Mohs Micrographic Surgery

“…CT scanning can occasionally distinguish air emboli from a thrombotic cerebrovascular accident or from an intracranial hemorrhage if, as in these two cases, air is visualized within cerebral vascular structures, 23 but a negative study does not definitively exclude air embolism, particularly if the associated symptoms are mild. 13 The volume of intravascular air present on CT imaging does not strongly correlate with the extent of cerebral infarction or with clinical symptoms. 24 Scalp surgery is typically safe because of the definitive separation of the intraosseous diploic venous system from the extracranial soft tissue venous drainage system of the scalp and adjacent soft tissues, but there are occasional anomalous connections between the diploic and surface venous drainage systems.…”

“…Gas emboli can cause mechanical obstruction of any arterial structure. In skeletal muscle and viscera, these emboli are often physiologically inconsequential, 1 but occlusion of the cardiac or cerebral arteries is particularly dangerous because even brief periods of relative hypoxia often damage the heart and brain 13 . In the brain, gas emboli travel to small arteries, where they cause deleterious effects through mechanical obstruction of the small vessels' luminae, and through the generation of damaging inflammatory responses to the lodged bubbles 13 …”

“…With arterial emboli, the presence of neurological symptoms in an operative setting should lead to a suspicion of air embolism. CT scanning can occasionally distinguish air emboli from a thrombotic cerebrovascular accident or from an intracranial hemorrhage if, as in these two cases, air is visualized within cerebral vascular structures, 23 but a negative study does not definitively exclude air embolism, particularly if the associated symptoms are mild 13 . The volume of intravascular air present on CT imaging does not strongly correlate with the extent of cerebral infarction or with clinical symptoms 24 …”

“…In skeletal muscle and viscera, these emboli are often physiologically inconsequential, 1 but occlusion of the cardiac or cerebral arteries is particularly dangerous because even brief periods of relative hypoxia often damage the heart and brain. 13 In the brain, gas emboli travel to small arteries, where they cause deleterious effects through mechanical obstruction of the small vessels' luminae, and through the generation of damaging inflammatory responses to the lodged bubbles. 13 In general, dermatologic surgery of the scalp is safe because the venous drainage of the skin and soft tissues of the scalp, like the venous drainage of all areas of skin and soft tissue, is initially external, and these thin-walled venous structures typically collapse easily, preventing boluses of air from entering the deeper draining venous systems of the head and neck.…”

Gas Embolism Caused by Portal Vein Gas: Case Report and Literature Review

“…A patent foramen ovale is detectable in about 30% of the general population [ 6 ]. Obstruction of either the coronary arteries or the nutritive arteries of the brain is especially serious [ 7 ]. The patient's comorbidity may also influence the outcome of circulating air emboli.…”