Venous Air Embolism during Surgery, Especially Cesarean Delivery

Kim, Chang Seok; Liu, Jia; Kwon, Ja Young; Shin, Seokyung; Kim, Ki Jun

doi:10.3346/jkms.2008.23.5.753

Cited by 86 publications

(19 citation statements)

References 81 publications

(96 reference statements)

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“…The incidence of VAE has been shown to vary according to type of medical or surgical procedures 8. In posterior fossa surgery, the incidence of VAE was 76% 9.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

Shin

Kwon

et al. 2013

Yonsei Med J

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PurposeVenous air embolism (VAE) is characterized by the entrainment of air or exogenous gases from broken venous vasculature into the central venous system. No study exists regarding the effect of patient positioning on the incidence of VAE during abdominal myomectomy. The purpose of this study was to assess the incidence and grade of VAE during abdominal myomectomy in the supine position in comparison to those in the head-up tilt position using transesophageal echocardiography.Materials and MethodsIn this study, 84 female patients of American Society of Anesthesiologist physical status I or II who were scheduled for myomectomy under general anesthesia were included. Patients were randomly divided into two groups: supine group and head-up tilt group. Transesophageal echocardiography images were videotaped throughout the surgery. The tapes were then reviewed for VAE grading.ResultsIn the supine group, 10% of the patients showed no VAE. Moreover, 10% of the patients were classified as grade I VAE, while 50% were categorized as grade II, 22.5% as grade III, and 7.5% as grade IV. In the head-up tilt group, no VAE was detected in 43.2% of the patients. In addition, 18.2% of the patients were classified as grade I VAE, 31.8% as grade II, and 6.8% as grade III; no patients showed grade IV. VAE grade in the head-up tilt group was significantly lower than that in the supine group (p<0.001).ConclusionThe incidence and grade of VAE in the head-up tilt group were significantly lower than those in the supine group during abdominal myomectomy.

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“…The incidence of VAE has been shown to vary according to type of medical or surgical procedures 8. In posterior fossa surgery, the incidence of VAE was 76% 9.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

Shin

Kwon

et al. 2013

Yonsei Med J

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“…Carbon dioxide embolism with clinically significant haemodynamic compromise is a rare, although potentially lethal, phenomenon. It is caused by entrapment of the gas into a solid organ, injured vein or artery, and results in obstruction of outflow from the right ventricle or pulmonary artery 2. Carbon dioxide embolism may occur at various steps of laparoscopic surgery: during insufflation to create the pneumoperitoneum carbon dioxide may directly enter into a blood vessel or solid organ due to misplacement of the Veress needle; lesser volume of gas may be entrained into circulation through an opening in injured blood vessels either in the abdominal wall or at the site of surgery3 ; direct absorption of carbon dioxide into a venous plexus may result when the rate of gas flow is high resulting in insufflation of gas at a higher pressure than the vascular pressure4 ; this forces the entry of carbon dioxide as bubbles into the circulation and results in a gas lock in the right ventricle, right ventricular outflow tract and pulmonary arteries resulting in ventilation perfusion mismatch 5…”

Section: Discussionmentioning

confidence: 99%

Seesawing end-tidal carbon dioxide: portent of critical carbon dioxide embolism in retroperitoneoscopy

Abraham

Jose²,

Paul

2018

BMJ Case Reports

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An abrupt increase in end-tidal CO (EtCO; from 35 to 58 mm Hg) followed by a sudden fall (to 18 mm Hg) was noted during retroperitoneoscopic adrenalectomy under general anaesthesia in a 23-year-old patient with adrenal hyperplasia. This was accompanied by hypotension (systolic blood pressure of 60 mm Hg), desaturation (88% SpO2) and ST depression (3.5 mm). The patient was resuscitated with fluids and vasopressor drugs and about 4 mL of air was aspirated through the central venous catheter, confirming the diagnosis of an intraoperative gas embolism. Later, a rent in the adrenal vein extending into the inferior vena cava was discovered and sutured. The blood pressure, EtCO, ST segment and pulse oximetry returned to normal after 15 min. This case demonstrates that gas embolism may transpire during retroperitoneoscopic adrenalectomy and an acute rise followed by a sharp fall in EtCO should alert the anaesthesiologist to this rare but potentially fatal complication.

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“…After surgery, mercury spread out along the spinal canal and along the venous structure to the pulmonary artery. There have been many reported cases of air embolism during operation 4,8,10,14,15) . We assumed that not only air or gas but mercury as well could be transported by vessel, if it is contacted with exposed cancellous bone during bone works.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Systemic Dissemination of Injected Elemental Mercury

Kang

Park

Moon³

2011

J Korean Neurosurg Soc

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Under general anesthesia, prone position and C-arm fluoroscopic guided, midline skin incision and subperiosteal dissection to approach the right side of high cervical area was done. To avoid metal vaporization, cauterization was used cautiously. Exposed silver-colored liquid during dissection were evacuated. When right side C3 hemilaminectomy was done and ligament flavum removed, the silver-colored liquid gushed out from the spinal canal. Exposed cervical dura was thickened owing to inflammations around the dura. In the operation field, all silverlike materials were removed. Drain catheter was inserted and operation wound was closed. On the left side of the neck, because of the muscular bleeding, C-arm fluoroscopy guided nee- INTRODUCTIONThere are many reports about mercury poisoning 6) . Many people suffer from mercury poisoning in the industrial field, owing to environmental disasters, by accidents and even including suicidal trial. Various treatment options have been applied for the poisoned patients. However, surgical treatments are required in restricted state. Authors have experienced one case of injected mercury patients and report the complication after surgery with literature review. To our knowledge, it is the first report on surgery related vascular dissemination. CASE REPORTA 19-year-old man in good previous health was transferred, There were only a few reports of mercury on pulmonary artery. However, there is no data on surgery related mercury dissemination. The objective of the present article is to describe one case of postoperative injected mercury dissemination. A 19-year-old man presented severe neck pain including meningeal irritation sign and abdominal pain after injection of mercury for the purpose of suicide. Radiologic study showed injected mercury in the neck involving high cervical epidural space and subcutaneous layer of abdomen. Partial hemilaminectomy and open mercury evacuation of spinal canal was performed. For the removal of abdominal subcutaneous mercury, C-arm guided needle aspiration was done. After surgery, radiologic study showed disseminated mercury in the lung, heart, skull base and low spinal canal. Neck pain and abdominal pain were improved after surgery. During 1 month after surgery, there was no symptom of mercury intoxication except increased mercury concentration of urine, blood and hair. We assumed the bone work during surgery might have caused mercury dissemination. Therefore, we recommend minimal invasive surgical technique for removal of injected mercury. If open exposures are needed, cautious surgical technique to prohibit mercury dissemination is necessary and normal barrier should be protected to prevent the migration of mercury.J Korean Neurosurg Soc 49 : 245-247, 2011 10.3340/jkns.2011.49.4.245 Copyright © 2011 The Korean Neurosurgical Society Print ISSN 2005-3711 On-line ISSN 1598-

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Venous Air Embolism during Surgery, Especially Cesarean Delivery

Cited by 86 publications

References 81 publications

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

Seesawing end-tidal carbon dioxide: portent of critical carbon dioxide embolism in retroperitoneoscopy

Postoperative Systemic Dissemination of Injected Elemental Mercury

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