Transesophageal Echocardiographic Diagnosis of Carbon Dioxide Embolism During Minimally Invasive Saphenous Vein Harvesting and Treatment with Inhaled Epoprostenol

Martineau, André; Arcand, Geneviève; Couture, Pierre; Babin, Denis; Perreault, L; Denault, André

doi:10.1213/01.ane.0000048827.03602.3f

Cited by 30 publications

(25 citation statements)

References 12 publications

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“…Although it is a very useful device, gas embolism is a possible complication caused by high flow and pressure. Several cases of gas embolism by a CO 2 blower during endoscopic saphenectomy for CABG have been reported [1][2][3], and there has been only one report that gas embolism by CO 2 flow into injured an coronary vein leads to critical condition during CABG in the English literature [4]. In this report, we describe a rare case of pulmonary embolism (PE) caused by CO 2 flow into a torn right ventricular outflow track (RVOT) during off-pump CABG.…”

Section: Introductionmentioning

confidence: 91%

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

et al. 2010

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We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism.

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Section: Introductionmentioning

confidence: 91%

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

et al. 2010

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“…Echocardiography may become more important in the diagnosis of VAE outside the operating room as expertise and equipment availability increase in the critical care environment. Pressure infusion devices [53][54][55] Shoulder arthroscopy 16,17 Mechanical ventilation 3,4,37 Surgery on the spine 18,19 Cavitron ultrasonic surgical aspirator® for hepatic resection 38,39 Total hip arthroplasty 20 Argon beam coagulator [40][41][42] Cesarean delivery 21 YAG laser 34 Prostate surgery 22,23 Endoscopic vein harvesting [43][44][45] Liver surgery 24 -26 Endoscopy 46 -48 Eye surgery 27 Use of hydrogen peroxide [49][50][51][52] 58 These pressures can easily exceed venous pressure depending on the patient's volume status and position. Because insufflation during gastrointestinal endoscopy is intermittent and low pressure, the risk of VAE is low.…”

Section: Surgery Above the Heartmentioning

confidence: 99%

“…87 Anecdotally, inhaled epoprostenol has been used successfully after carbon dioxide embolism, resulting in prompt normalization of PAP. 45 Positive pressure ventilation should be provided when needed after VGE, with the appreciation that high levels of positive end-expiratory pressure may establish a gradient that promotes right-left shunting through a PFO.…”

Section: Supportive Measures and Oxygen Therapymentioning

confidence: 99%

Venous Air Embolism

Borromeo

2010

Surgical Intensive Care Medicine

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DefinitionsGas embolism refers to the abnormal presence of gas within the circulatory system. It is a known complication of various surgical, therapeutic, and diagnostic procedures. It can also occur as a result of trauma. Gas embolism may be asymptomatic or may even result in immediate cardiovascular collapse. The type and severity of sequelae depend on the composition and amount of gas, the rate and location of entry, and on patient characteristics such as size, cardiopulmonary reserve, and presence of an intracardiac rightleft communication. An understanding of the etiologies and pathophysiology of gas embolism is important in order to recognize, treat, and, most importantly, prevent this potentially catastrophic complication.Gas enters the circulation when two conditions co-exist: (1) a communication between a gas source and the vascular system, and (2) a pressure gradient that favors gas entry into the vasculature. When the atmosphere is the source of gas, then this condition is termed air embolism. Gas can be entrained into open veins or venous sinuses, insufflated into traumatized vessels, or accidentally infused under pressure through indwelling venous or arterial catheters. Rarely, dissolved gas is released in blood through effervescence caused by rapid re-warming or decompression. 1 Venous (pulmonary) gas embolism (VGE) refers to gas that gains entry into the venous system and causes morbidity via its effects on the right heart and pulmonary vasculature. Systemic (arterial) gas embolism (SGE) results from gas that is propelled by the left heart and embolizes to systemic arterial beds causing ischemia and infarction. Paradoxical gas embolism (PGE) originates in the venous system and gains access to the arterial system through intracardiac defects or the pulmonary circulation.

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“…138 Whereas the incidence of bacteremia is not altered by biopsies, 139 it ranges from 2% to 15% after diagnostic upper GI endoscopy. 139 Reports vary with regards to TEE, from stating a very low incidence of bacteremia, similar to anticipated blood culture contamination rates, 140,141 to declaring an incidence of 0% to 17% 119,[142][143][144] in ambulatory and ICU patients. 139 Thus far, only two cases of bacterial endocarditis temporally related to TEE examination have been reported.…”

Section: Iv-infections and Prophylactic Antibioticsmentioning

confidence: 99%

“…139 Thus far, only two cases of bacterial endocarditis temporally related to TEE examination have been reported. 142,145 The single study in 24 patients reporting a 17% [143][144][145][146] incidence of transient bacteremia, but no endocarditis, concluded that bacteremia was common, and that antibiotic therapy should be routinely instituted during TEE. 143 However, the isolated organisms in that study were not sensitive to the antimicrobial prophylactic agents recommended by the American Heart Association (AHA).…”

Section: Iv-infections and Prophylactic Antibioticsmentioning

confidence: 99%

Transesophageal echocardiography-related complications

Côté

Denault

2008

Can J Anesth/J Can Anesth

106

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Purpose: The use of transesophageal echocardiography has increased over the past several years. It is generally considered a safe diagnostic and monitoring tool. Whereas complications associated with echocardiographic examination rarely occur, such complications must be known to echocardiographers performing these examinations. The purpose of this review is to summarize potential complications associated with transesophageal echocardiography. Sources:A systematic search of the English and French literature was undertaken using PubMed from the National Library of Medicine. Relevant articles were obtained from a Medline search spanning the years 1975 -2007, and their reference lists were used to retrieve additional articles. Principal findings:Complications of transesophageal echocardiography are primarily related to the gastrointestinal, cardiovascular, and respiratory systems, and include infection, toxic drug reaction, local reaction through contamination of the probe, and ultrasound cavitation. Strategies to prevent these complications are reviewed. Conclusion:Whereas transesophageal echocardiography is associated with a low complication rate, the echocardiographer must be knowledgeable about the types of complications and their predisposing factors, and should be meticulous in preventing their occurrence.

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Transesophageal Echocardiographic Diagnosis of Carbon Dioxide Embolism During Minimally Invasive Saphenous Vein Harvesting and Treatment with Inhaled Epoprostenol

Cited by 30 publications

References 12 publications

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

Venous Air Embolism

Transesophageal echocardiography-related complications

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