Recent Advances in Monitoring Pulmonary Air Embolism

Brechner, Verne L.; Bethune, Robert W. M.

doi:10.1213/00000539-197103000-00020

Cited by 23 publications

(8 citation statements)

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“…The right atrial catheter has become a very important tool in the diagnosis and treatment of air embolism. Monitoring of end-expiratory CO, concentration and its applications for detection of air embolism were described earlier (BETHUNE & BRECHNER 1968, BRECHNER & BETHUNE 1971. Recently a Swan-Ganz catheter was used for pulmonary artery pressure monitoring in a case of air embolism during posterior fossa surgery (MUNSON et al 1975).…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of Posterior Fossa Surgery in the Sitting Position

Albin

Babinski

Maroon

et al. 1977

Survey of Anesthesiology

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From the surgical aspect, the sitting position gives good surgical access to the operative site, improves venous drainage, gives a better view of facial area for monitoring evoked responses from cranial nerve stimulation and allows for better ventilation. Conversely, the sitting position can present complications such as air emboli, postural hypotension and serious cardiac arrhythmias due to surgical stimulation of cranial nerves and brainstem.This paper presents our clinical experience in 180 neurosurgical procedures on the posterior fossa in the sitting position. The standardized anesthetic technique consisted of narcotic, muscle relaxant, nitrous oxide and controlled ventilation. All patients were monitored with EGG, direct arterial and venous pressure, discontinuous blood gases, and expiratory CO, and urinary output. Air embolism was detected via Doppler ultrasonic detector and evacuated through a right atrial catheter.Air was detected, visualized and aspirated in 45 cases for an incidence of 25%, with most episodes occurring early in the procedure. In 11 cases (6%) air was detected on closure. There were no deaths in this series.Fifty-eight patients (32%) had a 10-20 mmHg drop in blood pressure on reaching the sitting position, 19 became temporarily hypertensive (10.5%), and the remainder were normotensive. In 46 patients (25%), bradycardia developed during retraction-manipulation-stimulation of structures on or adjacent to brainstem as well as to cranial nerves. Surgical stress also accounted for the 13 patients (7%) having frequent premature ventricular extrasystoles. One case of profound hypotension and another case of virtual cardiac standstill were noted during the use of the bipolar electrocautery at or near the fifth nerve exit from brainstem. Additional hemodynamic data, the physiopathology, diagnosis and treatment of air embolism is discussed.

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Section: Discussionmentioning

confidence: 99%

Anesthetic Management of Posterior Fossa Surgery in the Sitting Position

Albin

Babinski

Maroon

et al. 1977

Survey of Anesthesiology

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“…In a study of Albin et al [1] done in 180 patients, they used precordial Doppler for diagnosis of VAE and the incidence of VAE they found was 25%. By monitoring ETCO 2 some authors have described the incidence of VAE from 7% to 40% [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Kore¹,

Waghalkar²,

Shetty³

et al. 2016

Int J of Biomed & Adv Res

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Aims and Objective: To assess the outcome following posterior fossa craniotomy in sitting position with respect to hemodynamic changes as well as intra and post operative complications. Material and Method: The present study was conducted in150 adult patients undergoing posterior fossa craniotomy in sitting position under general anaesthesia. Induction was done with thiopentone sodium 5mg/kg. Neuromuscular blockade was achieved with vecuronium bromide 0.1mg/kg to facilitate intubation. Radial arterial line was inserted preferably in left hand side for invasive blood pressure monitoring. Sitting position was given to patients' slowly over 20-30 minutes. Vital of the patients were monitored during and after giving sitting position. Patients were observed in ICU for first 48 hrs for neurological status, cardiovascular status, respiratory and surgical complications. Results: We found significant hemodynamic changes during and after giving sitting position to the patients which returned back to normal after 2 hrs of position. There were no perioperative cardiac events and neurological alteration. The incidence of venous air embolism was 5.3% and it was not associated with any postoperative morbidity and mortality. Other complications observed were pneumocephalous (0.7%), tongue oedema (2%) and glossopharyngeal nerve palsy (0.7%). Conclusions: Use of sitting position for posterior fossa surgery is safe anesthetic techniques and presents unique challenges for the anesthetist; taking measures to minimize hypotension and postoperative complications.

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“…With large emboli and cardiovascular collapse, a sound resembling a squeezing sponge may be heard in the cardiac area. 31 Wheezing as a result of acute bronchospasm may be heard. Evidence of elevated rightsided heart pressures and systemic hypotension are usually late signs seen with large air emboli.…”

Section: Presentationmentioning

confidence: 99%

Venous Air Embolism

O'Quin¹

1982

Arch Intern Med

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Recent Advances in Monitoring Pulmonary Air Embolism

Cited by 23 publications

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Anesthetic Management of Posterior Fossa Surgery in the Sitting Position

Anesthetic Management of Posterior Fossa Surgery in the Sitting Position

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Venous Air Embolism

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