Paradoxical air embolism after lower limb reconstruction.
ABSTRACT enous air embolism (VAE) is a serious compli- cation of surgeries performed with patients in the sitting position (l-3). Paradoxical air embo- lism can occur in any patient with a patent foramen ovale. We present a case of intraoperative paradoxical air embolism during a lower extremity limb recon- struction successfully treated using the Trendelenburg procedure (4). Case Report A 57-yr-old woman with osteomyelitis and squamous cell carcinoma of her left tibia was scheduled to undergo tumor resection and tibia1 reconstruction. Her past medical history was significant only for medically controlled hypertension, and the preoperative hematocrit was 29%. In addition to a 12-lead electrocardiogram, noninvasive blood pressure cuff and pulse oximeter, a radial arterial catheter was placed and a lumbar epidural catheter was inserted in the L3-4 in- terspace. A T-10 sensory level was established with incre- mental doses of 0.375% bupivacaine, and general anesthesia was induced with thiopental 200 mg and succinylcholine 100 mg intravenously (IV). After tracheal intubation, anes- thesia was maintained with 0.5% isoflurane in 30% O,/ balance N,O. An 8.5-Fr central venous catheter was placed in the right internal jugular vein with a 7.0-Fr 20-cm single lumen infusion catheter through it. Baseline central venous pressure (CVP) was 10 cm H,O and was monitored contin- uously through the side port. A tourniquet was placed on the upper thigh and inflated to 250 mm Hg for the first 2 h of surgery. A proximal tibia1 resection was performed with a knee fusion reconstruction using a long tibia1 plate. Wound coverage involved medial and lateral gastrocnemius flaps with skin grafts. The extrem- ity tourniquet was deflated prior to wound closure. Tourni- quet deflation was associated with an increase in
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ABSTRACT: Between October 6, 1986 and September 17, 1987, 11 patients underwent insertion of mandibular dental prostheses by the same oral surgeon. Three patients suffered cardiac arrest during surgery and subsequently died. Two of the patients who died had received general anaesthetics and the other had intravenous sedation given by three different anaesthetists. All three patients arrested suddenly, developing profound cyanosis and electrical mechanical dissociation, underwent prolonged resuscitative efforts, and had marked hypoxaemia and hypercapnia, despite cardiopulmonary resuscitation. Two other patients had signs of injection of air but survived, one suffering cardiac collapse and the other sustaining massive subcutaneous emphysema. Air embolism was produced by inadvertent injection of a mixture of air and water, passing through the hollow dental drill, directly into the mandible to the facial and pterygoid plexus veins and thence to the superior vena cava and right atrium.Canadian Journal of Anaesthesia 02/1990; 37(1):112-21. · 2.13 Impact Factor
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ABSTRACT: Venous air embolism during neurosurgical procedures (detected by Doppler Ultrasound and aspiration via a right atrial catheter) was noted in 100 of 400 patients in the sitting position, 5 of 60 patients in the lateral position, 7 of 48 patients in the supine position, and 1 of 10 individuals monitored in the prone position. We confirmed venous air embolism in many of these cases by using serial technetium-macroaggregated albumin lung scans. Gravitational gradients from the venous portal of entrance to the right side of the heart were as small as 5.0 cm, with aspiration of 200 ml of air occurring. Doppler ultrasonic air bubble detection and aspiration through a previously inserted right atrial catheter are critical factors in the diagnosis and treatment of this condition.Neurosurgery 01/1978; 3(3):380-4. · 2.53 Impact Factor
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ABSTRACT: As an aid to correctly placing the needle tip within the hip joint during arthrography, injection of small amounts of air has been used to outline the joint space. Over a period of seven years, air embolus has been noted in three pediatric patients, twice with minor symptoms, and once with cardiac arrest. Even small amounts of air (less than 5 cc) injected accidentally intravenously may cause dangerous complications in small infants. If this technique is to be used, it is recommended that small amounts of carbon dioxide or oxygen be used instead of air.Skeletal Radiology 02/1981; 6(1):11-3. · 1.74 Impact Factor