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Deng X, Zhou J, Diao M, Li H, Lin X. Effects of different fractions of inspired oxygen on gas embolization during hysteroscopic surgery: A double-blind, randomized, controlled trial. Int J Gynaecol Obstet 2024; 164:1101-1107. [PMID: 37789807 DOI: 10.1002/ijgo.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Gas embolism is a common complication of hysteroscopic surgery that causes serious concern among gynecologists and anesthesiologists due to the potential risk to patients. The factors influencing gas embolism in hysteroscopic surgery have been extensively studied. However, the effect of the oxygen concentration inhaled by patients on gas embolism during hysteroscopic surgery remains elusive. Therefore, we designed a double-blind, randomized, controlled trial to determine whether different inhaled oxygen concentrations influence the occurrence of gas embolism during hysteroscopic surgery. METHODS This trial enrolled 162 adult patients undergoing elective hysteroscopic surgery who were randomly divided into three groups with inspired oxygen fractions of 30%, 50%, and 100%. Transthoracic echocardiography (four-chamber view) was used to evaluate whether gas embolism occurred. Before the start of surgery, the four-chamber view was continuously monitored. RESULTS The number of gas embolisms in the 30%, 50%, and 100% groups was 36 (69.2%), 30 (55.6%), and 24 (44.4%), respectively. The incidence of gas embolism gradually decreased with increasing inhaled oxygen concentration (P = 0.031). CONCLUSION In hysteroscopic surgery, a higher oxygen concentration inhaled by patients may reduce the incidence of gas embolism, indicating that a higher inhaled oxygen concentration, especially 100%, could be recommended for patients during hysteroscopic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=53779, Registration number: ChiCTR2000033202).
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Affiliation(s)
- Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Jieshu Zhou
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Min Diao
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Hao Li
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Xuemei Lin
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
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Fuentes S, Grande-Moreillo C, Margarit-Mallol J, Flores-Villar S, Solé-Heuberger E, Jaen-Manzanera A. Gas Embolism in Pediatric Minimally Invasive Surgery: Should It Be a Concern? J Laparoendosc Adv Surg Tech A 2023; 33:1011-1017. [PMID: 37253132 DOI: 10.1089/lap.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Introduction: Gas embolism can occur during minimally invasive surgical procedures. Its incidence and implications in infants and children are not clear. The objective of this study is to identify gas embolism with transthoracic echocardiography and its consequences in pediatric laparoscopic appendectomy. Materials and Methods: This is a descriptive observational study including children undergoing laparoscopic appendectomy. We performed transthoracic echocardiography during surgery and collected data on intraoperative hemodynamic and respiratory parameters. Results: To date, we have included 10 patients in whom intraoperative transthoracic echocardiography revealed a 50% incidence of gas embolism. All episodes of embolism were grade I or II, and the patients remained asymptomatic. The hemodynamic and respiratory parameters varied slightly during the pneumoperitoneum. Conclusions: Episodes of gas embolism in pediatric laparoscopic appendectomy appeared in up to 50% of patients. Although they were subclinical, we should be aware of the risk of serious events and take measures to maximize safety in pediatric minimally invasive surgery.
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Affiliation(s)
- Sara Fuentes
- Pediatric Surgery Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Carme Grande-Moreillo
- Pediatric Surgery Department, Hospital Universitari Mútua de Terrassa, Consorci Sanitari Alt Penedès i Garraf, Spain
| | - Jaume Margarit-Mallol
- Pediatric Surgery Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | | | | | - Angels Jaen-Manzanera
- Coordinadora Avaluació i Suport a la Recerca, Fundació Docència i Recerca Mútua Terrassa, Terrassa, Spain
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Zhang H, Wang S, Zhong F, Liao M. Risk factors for air embolism following computed tomography-guided percutaneous transthoracic needle biopsy: a systematic review and meta-analysis. Diagn Interv Radiol 2023; 29:478-491. [PMID: 36994842 PMCID: PMC10679610 DOI: 10.4274/dir.2022.221187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/07/2022] [Indexed: 01/15/2023]
Abstract
To quantitatively analyze the risk factors for air embolism following computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and qualitatively review their characteristics. The databases of PubMed, Embase, Web of Science, Wanfang Data, VIP information, and China National Knowledge Infrastructure were searched on January 4, 2021, for studies reporting the occurrence of air embolisms following CT-guided PTNB. After study selection, data extraction, and quality assessment, the characteristics of the included cases were qualitatively and quantitatively analyzed. A total of 154 cases of air embolism following CT-guided PTNB were reported. The reported incidence was 0.06% to 4.80%, and 35 (22.73%) patients were asymptomatic. An unconscious or unresponsive state was the most common symptom (29.87%). Air was most commonly found in the left ventricle (44.81%), and 104 (67.53%) patients recovered without sequelae. Air location (P < 0.001), emphysema (P = 0.061), and cough (P = 0.076) were associated with clinical symptoms. Air location (P = 0.015) and symptoms (P < 0.001) were significantly associated with prognosis. Lesion location [odds ratio (OR): 1.85, P = 0.017], lesion subtype (OR: 3.78, P = 0.01), pneumothorax (OR: 2.16, P = 0.003), hemorrhage (OR: 3.20, P < 0.001), and lesions located above the left atrium (OR: 4.35, P = 0.042) were significant risk factors for air embolism. Based on the current evidence, a subsolid lesion, being located in the lower lobe, the presence of pneumothorax or hemorrhage, and lesions located above the left atrium were significant risk factors for air embolism.
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Affiliation(s)
- Hanfei Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feiyang Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Blogg SL, Tillmans F, Lindholm P. The risk of decompression illness in breath-hold divers: a systematic review. Diving Hyperb Med 2023; 53:31-41. [PMID: 36966520 PMCID: PMC10106275 DOI: 10.28920/dhm53.1.31-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/26/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Breath-hold (BH) diving has known risks, for example drowning, pulmonary oedema of immersion and barotrauma. There is also the risk of decompression illness (DCI) from decompression sickness (DCS) and/or arterial gas embolism (AGE). The first report on DCS in repetitive freediving was published in 1958 and from then there have been multiple case reports and a few studies but no prior systematic review or meta-analysis. METHODS We undertook a systematic literature review to identify articles available from PubMed and Google Scholar concerning breath-hold diving and DCI up to August 2021. RESULTS The present study identified 17 articles (14 case reports, three experimental studies) covering 44 incidences of DCI following BH diving. CONCLUSIONS This review found that the literature supports both DCS and AGE as potential mechanisms for DCI in BH divers; both should be considered a risk for this cohort of divers, just as for those breathing compressed gas while underwater.
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Affiliation(s)
| | | | - Peter Lindholm
- Department of Emergency Medicine, University of California, San Diego, CA, USA
- Corresponding author: Professor Peter Lindholm, 200 W Arbor Drive, MC8676, San Diego, CA 92103, USA
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Risberg J. Acclimatization to diving: a systematic review. Undersea Hyperb Med 2021; 48:127-147. [PMID: 33975403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Multiday hyperbaric exposure has been shown to reduce the incidence of decompression sickness (DCS) of compressed-air workers. This effect, termed acclimatization, has been addressed in a number of studies, but no comprehensive review has been published. This systematic review reports the findings of a literature search. PubMed, Ovid Embase, The Cochrane Library and Rubicon Research Repository were searched for studies reporting DCS incidence, venous gas embolism (VGE) or subjective health reports after multiday hyperbaric exposure in man and experimental animals. Twenty-nine studies fulfilled inclusion criteria. Three epidemiological studies reported statistically significant acclimatization to DCS in compressed-air workers after multiday hyperbaric exposure. One experimental study observed less itching after standardized simulated dives. Two human experimental studies reported lower DCS incidence after multiday immersed diving. Acclimatization to DCS has been observed in six animal species. Multiday diving had less consistent effect on VGE after hyperbaric exposure in man. Four studies observed acclimatization while no statistically significant acclimatization was reported in the remaining eight studies. A questionnaire study did not report any change in self-perceived health after multiday diving. This systematic review has not identified any study suggesting a sensitizing effect of multiday diving, and there is a lack of data supporting benefit of a day off diving after a certain number of consecutive diving days. The results suggest that multiday hyperbaric exposure probably will have an acclimatizing effect and protects from DCS. The mechanisms causing acclimatization, extent of protection and optimal procedure for acclimatization has been insufficiently investigated.
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Affiliation(s)
- Jan Risberg
- Office of Submarine and Diving Medicine, Norwegian Armed Forces Joint Medical Services
- NUI AS, Bergen, Norway
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Chen J, Cox S, Kuklina EV, Ferre C, Barfield W, Li R. Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US. JAMA Netw Open 2021; 4:e2036148. [PMID: 33528553 PMCID: PMC7856547 DOI: 10.1001/jamanetworkopen.2020.36148] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge. OBJECTIVE To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020. EXPOSURES Timing of SMM diagnosis. MAIN OUTCOMES AND MEASURES Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention. RESULTS A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after hospital discharge; of those, 3993 cases (75.7%) in the commercial insurance cohort and 2399 cases (73.5%) in the Medicaid cohort were identified in the first 2 weeks after discharge. The most common factors associated with SMM varied based on the timing of diagnosis. In the Medicaid population, non-Hispanic Black women (adjusted odds ratio [aOR], 1.53; 95% CI, 1.48-1.58), Hispanic women (aOR, 1.46; 95% CI, 1.37-1.57), and women of other races or ethnicities (aOR, 1.40; 95% CI, 1.33-1.47) had higher rates of SMM during delivery hospitalization than non-Hispanic White women; however, only the disparity between Black and White women (aOR, 1.69; 95% CI, 1.57-1.81) persisted into the postdischarge period. CONCLUSIONS AND RELEVANCE In this study, 15.7% of SMM cases in the Medicaid cohort and 14.1% of SMM cases in the commercial insurance cohort first occurred after the delivery hospitalization, with notable disparities in factors and maternal characteristics associated with the development of SMM. These findings suggest a need to expand the focus of SMM assessment to the postdelivery discharge period.
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Affiliation(s)
- Jiajia Chen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena V. Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia Ferre
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanda Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rui Li
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Now with Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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Abstract
Multiday hyperbaric exposure has been shown to reduce the incidence of decompression sickness (DCS) of compressed-air workers. This effect, termed acclimatization, has been addressed in a number of studies, but no comprehensive review has been published. This systematic review reports the findings of a literature search. PubMed, Ovid Embase, The Cochrane Library and Rubicon Research Repository were searched for studies reporting DCS incidence, venous gas embolism (VGE) or subjective health reports after multiday hyperbaric exposure in man and experimental animals. Twenty-nine studies fulfilled inclusion criteria. Three epidemiological studies reported statistically significant acclimatization to DCS in compressed-air workers after multiday hyperbaric exposure. One experimental study observed less itching after standardized simulated dives. Two human experimental studies reported lower DCS incidence after multiday immersed diving. Acclimatization to DCS has been observed in six animal species. Multiday diving had less consistent effect on VGE after hyperbaric exposure in man. Four studies observed acclimatization while no statistically significant acclimatization was reported in the remaining eight studies. A questionnaire study did not report any change in self-perceived health after multiday diving. This systematic review has not identified any study suggesting a sensitizing effect of multiday diving, and there is a lack of data supporting benefit of a day off diving after a certain number of consecutive diving days. The results suggest that multiday hyperbaric exposure probably will have an acclimatizing effect and protects from DCS. The mechanisms causing acclimatization, extent of protection and optimal procedure for acclimatization has been insufficiently investigated.
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Affiliation(s)
- Jan Risberg
- Office of Submarine and Diving Medicine, Norwegian Armed Forces Joint Medical Services
- NUI AS, Bergen, Norway
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Kayano S, Ota H, Yamaguchi T, Ono K, Takase K. Association of the incidence of venous air embolism on coronary computed tomography angiography with the intravenous access route preparation process. Medicine (Baltimore) 2019; 98:e17940. [PMID: 31702683 PMCID: PMC6855638 DOI: 10.1097/md.0000000000017940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.
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Affiliation(s)
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai
| | - Takayoshi Yamaguchi
- Department of Radiological Technology, Hanaoka Seishu Memorial Cardiovascular Clinic, Sapporo, Japan
| | | | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai
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Ånell R, Grönkvist M, Eiken O, Gennser M. Nitrogen Washout and Venous Gas Emboli During Sustained vs. Discontinuous High-Altitude Exposures. Aerosp Med Hum Perform 2019; 90:524-530. [PMID: 31101137 DOI: 10.3357/amhp.5207.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: The frequency of long-duration, high-altitude missions with fighter aircraft is increasing, which may increase the incidence of decompression sickness (DCS). The aim of the present study was to compare decompression stress during simulated sustained high-altitude flying vs. high-altitude flying interrupted by periods of moderate or marked cabin pressure increase.METHODS: The level of venous gas emboli (VGE) was assessed from cardiac ultrasound images using the 5-degree Eftedal-Brubakk scale. Nitrogen washout/uptake was measured using a closed-circuit rebreather. Eight men were investigated in three conditions: one 80-min continuous exposure to a simulated cabin altitude of A) 24,000 ft, or four 20-min exposures to 24,000 ft interspersed by three 20-min intervals at B) 20,000 ft or C) 900 ft.RESULTS: A and B induced marked and persistent VGE, with peak bubble scores of [median (range)]: A: 2.5 (1-3); B: 3.5 (2-4). Peak VGE score was less in C [1.0 (1-2), P < 0.01]. Condition A exhibited an initially high and exponentially decaying rate of nitrogen washout. In C the washout rate was similar in each period at 24,000 ft, and the nitrogen uptake rate was similar during each 900-ft exposure. B exhibited nitrogen washout during each period at 24,000 ft and the initial period at 20,000 ft, but on average no washout or uptake during the last period at 20,000 ft.DISCUSSION: Intermittent reductions of cabin altitude from 24,000 to 20,000 ft do not appear to alleviate the DCS risk, presumably because the pressure increase is not sufficient to eliminate VGE. The nitrogen washout/uptake rate did not reflect DCS risk in the present exposures.Ånell R, Grönkvist M, Eiken O, Gennser M. Nitrogen washout and venous gas emboli during sustained vs. discontinuous high-altitude exposures. Aerosp Med Hum Perform. 2019; 90(6):524-530.
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10
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Abstract
Inadvertent exposure to radiation, chemical agents and biological factors are well recognized hazards associated with the health care delivery system. Less well appreciated yet no less harmful is risk of decompression sickness in those who accompany patients as inside attendants (IAs) during provision of hyperbaric oxygen therapy. Unlike the above hazards where avoidance is practiced, IA exposure to decompression sickness risk is unavoidable. While overall incidence is low, when calculated as number of cases over number of exposures or potential for a case during any given exposure, employee cumulative risk, defined here as number of cases over number of IAs, or risk that an IA may suffer a case, is not. Commonly, this unique occupational environmental injury responds favorably to therapeutic recompression and a period of recuperation. There are, however, permanent and career-ending consequences, and at least two nurses have succumbed to their decompression insults. The intent of this paper is to heighten awareness of hyperbaric attendant decompression sickness. It will serve as a review of reported cases and reconcile incidence against largely ignored individual worker risk. Mitigation strategies are summarized and an approach to more precisely identify risk factors that might prompt development of consensus screening standards is proposed.
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Affiliation(s)
- Richard Clarke
- National Baromedical Services, Columbia, South Carolina, U.S
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Rushatamukayanunt P, Seanho P, Muangman S, Raksakietisak M. Severe Venous Air Embolism Related to Positioning in Posterior Cranial Fossa Surgery in Siriraj Hospital. J Med Assoc Thai 2016; 99:511-516. [PMID: 27501605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Posterior cranial fossa surgery is commonly performed under sitting and horizontal position in our institution. Venous air embolism is a potentially serious complication of neurosurgery especially in the sitting position. OBJECTIVE We aim to compare the incidence of severe venous air embolism and other complications of both positions. MATERIAL AND METHOD A retrospective analysis of medical record was performed in 192 patients undergoing posterior cranial fossa craniotomy from January 2010 to December 2013. Data collected from the records included demographic profile, patient position, hemodynamic changes, venous air embolism (VAE), blood loss/transfusion, duration of surgery, postoperative complications, duration of ICU stay, and postoperative discharge status. The definition of severe air embolism was identified as suspected VAE with decreased systolic blood pressure greater than 20%. RESULTS There were 92 patients in sitting position (SP) group and 100 patients in horizontal position (HP) group. The incidence of severe venous air embolism was signficantly higher in SP group compared with HP group (41.3% vs. 11.0%, p<0. 001). SP group had more complications than HP group in both central nervous system (71% vs. 34.0%, p = 0.001), and cardiovascular system (17% vs. 6%, p = 0.001). Although postoperative ventilator time in SP group was less than HP group (1.24 vs. 1.60 days, p = 0.029), ICU and hospital stay were not different in either group. CONCLUSION The incidence of severe venous air embolism detected by end tidal CO₂ was significantly higher in SP group. However, 11% of HP group were suspected of severe air embolism.
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Matte GS, Connor KR, Liu H, DiNardo JA, Faraoni D, Pigula F. Arterial Limb Microemboli during Cardiopulmonary Bypass: Observations from a Congenital Cardiac Surgery Practice. J Extra Corpor Technol 2016; 48:5-10. [PMID: 27134302 PMCID: PMC4850225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/29/2016] [Indexed: 06/05/2023]
Abstract
Gaseous microemboli (GME) are known to be delivered to the arterial circulation of patients during cardiopulmonary bypass (CPB). An increased number of GME delivered during adult CPB has been associated with brain injury and postoperative cognitive dysfunction. The GME load in children exposed to CPB and its consequences are not well characterized. We sought to establish a baseline of arterial limb emboli counts during the conduct of CPB for our population of patients requiring surgery for congenital heart disease. We used the emboli detection and counting (EDAC) device to measure GME activity in 103 consecutive patients for which an EDAC machine was available. Emboli counts for GME <40 μ and >40 μ were quantified and indexed to CPB time (minutes) and body surface area (BSA) to account for the variation in patient size and CPB times. Patients of all sizes had a similar embolic burden when indexed to bypass time and BSA. Furthermore, patients of all sizes saw a three-fold increase in the <40 μ embolic burden and a five-fold increase in the >40 μ embolic burden when regular air was noted in the venous line. The use of kinetic venous-assisted drainage did not significantly increase arterial limb GME. Efforts for early identification and mitigation of venous line air are warranted to minimize GME transmission to congenital cardiac surgery patients during CPB.
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Affiliation(s)
- Gregory S. Matte
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Kevin R. Connor
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Hua Liu
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - James A. DiNardo
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts
| | - David Faraoni
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts
| | - Frank Pigula
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Hsu M, Trerotola SO. Air embolism during insertion and replacement of tunneled dialysis catheters: a retrospective investigation of the effect of aerostatic sheaths and over-the-wire exchange. J Vasc Interv Radiol 2015; 26:366-71. [PMID: 25638749 DOI: 10.1016/j.jvir.2014.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/21/2014] [Accepted: 11/27/2014] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To determine the impact of the introduction of aerostatic sheaths on air embolism (AE) events during tunneled dialysis catheter (TDC) insertion and to characterize such events occurring during over-the-wire exchange (OTWE). MATERIALS AND METHODS Between July 2001 and April 2013, 5,789 TDCs were placed, including 3,963 de novo placements, 1,811 OTWEs, and 15 tract recanalizations. There were 15 AE events reported, and the medical records of these patients were reviewed. The effect of aerostatic sheaths, introduced in July 2005, was compared with the period before their introduction; the same TDC design was used throughout. RESULTS Of the 15 AE events, 10 occurred during de novo placement (10 of 3,963 placement; 0.25%), 4 occurred during OTWE (4 of 1,811 placements; 0.22%), and 1 occurred during tract recanalization. With regard to aerostatic sheaths in de novo TDC placement, 4 of 1,174 (0.34%) AE events occurred before aerostatic sheath introduction, and 6 of 2,789 (0.22%) AE events occurred after aerostatic sheath introduction. These rates did not differ statistically (P = .5). CONCLUSIONS Use of aerostatic sheaths trended toward reducing AE events during de novo TDC placement. This trend was not statistically significant, probably owing to the rarity of AE despite the large sample size. Air embolism occurs during OTWE at a rate similar to de novo placement with aerostatic sheaths as well as during tract recanalization.
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Affiliation(s)
- Michael Hsu
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104..
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Ranapurwala SI, Bird N, Vaithiyanathan P, Denoble PJ. Scuba diving injuries among Divers Alert Network members 2010-2011. Diving Hyperb Med 2014; 44:79-85. [PMID: 24986725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Scuba diving injuries vary greatly in severity and prognosis. While decompression sickness (DCS) and arterial gas embolism can be tracked easily, other forms of diving injury remain unaccounted for. PURPOSE The purpose of this paper is to assess rates of overall self-reported scuba-diving-related injuries, self-reported DCS-like symptoms, and treated DCS and their association with diver certification level, diving experience and demographic factors. METHODS We analyzed self-reported data from a Divers Alert Network membership health survey conducted during the summer of 2011. Poisson regression models with scaled deviance were used to model the relative rates of reported injuries. Models were adjusted for sex, age, body mass index (BMI) and average annual dives, based on the bias-variance tradeoff. RESULTS The overall rate of diving-related injury was 3.02 per 100 dives, self-reported DCS symptoms was 1.55 per 1,000 dives and treated DCS was 5.72 per 100,000 dives. Diving-related injury and self-reported DCS symptom rates decreased for higher diver certification levels, increasing age, increasing number of average annual dives and for men; they increased for increasing BMI. CONCLUSIONS Diving injury rates may be higher than previously thought, indicating a greater burden on the diving community. Self-reported DCS-like symptoms are a small fraction of all dive-related injuries and those receiving treatment for DCS are an even smaller fraction. The small number of divers seeking treatment may suggest the mild nature and a tendency towards natural resolution for most injuries.
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Affiliation(s)
- Shabbar I Ranapurwala
- Divers Alert Network, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA, Divers Alert Network, 6 West Colony Place, Durham, NC 27705, USA, E-mail:
| | - Nicholas Bird
- Duke Urgent Care, Duke University Health System, Durham, NC, USA
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Morgan GJ, Benson L. Reducing air embolism and improving accuracy during pediatric wedge measurements. J Invasive Cardiol 2013; 25:320. [PMID: 23735362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Gareth J Morgan
- Bristol Congenital Heart Centre, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom.
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Abstract
PURPOSE Venous 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 METHODS In 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. RESULTS In 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). CONCLUSION The 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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Affiliation(s)
- Jiwon An
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Kyung Shin
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Dardeau MR, Pollock NW, McDonald CM, Lang MA. The incidence of decompression illness in 10 years of scientific diving. Diving Hyperb Med 2012; 42:195-200. [PMID: 23258455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/25/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The American Academy of Underwater Science (AAUS) constitutes the single largest pool of organizations with scientific diving programmes in North America. Members submit annual summaries of diving activity and any related incidents. METHODS All diving records for a 10-year period between January 1998 and December 2007 were reviewed. Incidents were independently classified or reclassified by a four-person panel with expertise in scientific diving and diving safety using a previously published protocol. Subsequent panel discussion produced a single consensus classification of each case. RESULTS A total of 95 confirmed incidents were reported in conjunction with 1,019,159 scientific dives, yielding an overall incidence of 0.93/10,000 person-dives. A total of 33 cases were determined to involve decompression illness (DCI), encompassing both decompression sickness and air embolism. The incidence of DCI was 0.324/10,000 person-dives, substantially lower than the rates of 0.9-35.3/10,000 published for recreational, instructional/guided, commercial and/or military diving. CONCLUSIONS Scientific diving safety may be facilitated by a combination of relatively high levels of training and oversight, the predominance of shallow, no-decompression diving and, possibly, low pressure to complete dives under less than optimal circumstances.
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Abstract
Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.
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Affiliation(s)
- Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Gloviczki P. Invited commentary. J Vasc Surg 2010; 53:137-8. [PMID: 21184934 DOI: 10.1016/j.jvs.2010.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 07/30/2010] [Accepted: 07/30/2010] [Indexed: 11/16/2022]
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Fischler M. Occurrence of a carbon dioxide embolism during laparoscopic pyloromyotomy in a small child: several unresolved questions. Can J Anaesth 2010; 58:226; author reply 226-7. [PMID: 21132476 DOI: 10.1007/s12630-010-9425-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/09/2010] [Indexed: 11/26/2022] Open
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Connolly DM, Lee VM, D'Oyly TJ. Decompression sickness risk at 6553 m breathing two gas mixtures. Aviat Space Environ Med 2010; 81:1069-1077. [PMID: 21197850 DOI: 10.3357/asem.2837.2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The risk of severe decompression sickness (DCS) increases rapidly above 6248 m (20,500 ft) and is greater when breathing higher proportions of inert gas. Contemporary aircrew may be exposed to higher cabin altitudes while breathing molecular sieve oxygen concentrator (MSOC) product gas containing variable concentrations of oxygen, nitrogen, and argon. This study assessed the risk of DCS at 6553 m (21,500 ft) breathing two simulated MSOC product gas mixtures. METHODS In a hypobaric chamber, 10 subjects each undertook 2 4-h exposures at 6553 m breathing either 75% O2:21% N2:4% Ar or 56% 02:42% N2:2% Ar. Subjects undertook regular activities simulating in-flight movements of fast jet aircrew. Venous gas emboli (VGE) "bubble" load was graded every 15 min using 2D and Doppler echocardiography by experienced operators blinded to breathing gas composition. RESULTS DCS occurred in five exposures (25%), the earliest after less than 90 min at altitude. All were minor, single-site, uncomplicated limb bends that resolved with recompression. VGE occurred in 85% of exposures with some early-onset, heavy loads. Survival (Probit) analysis indicated that breathing 56% oxygen significantly decreased VGE latency relative to breathing 75% oxygen (relative potency 3.05). CONCLUSIONS From 20 experimental exposures, the risk of DCS at 6553 m is estimated at 5% by 90 min and 20% at 3 h. Exploiting the negative predictive value of VGE latency as a surrogate measure of protection from DCS, at high cabin altitudes better MSOC performance (higher product gas oxygen concentrations) will protect more aircrew for longer.
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Affiliation(s)
- Desmond M Connolly
- Aircrew Systems Group, Human Protection and Performance Enhancement, QinetiQ PLC, Farnborough, Hants, UK.
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Gupta R, Vora N, Thomas A, Crammond D, Roth R, Jovin T, Horowitz M. Symptomatic cerebral air embolism during neuro-angiographic procedures: incidence and problem avoidance. Neurocrit Care 2008; 7:241-6. [PMID: 17805494 DOI: 10.1007/s12028-007-0041-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND While clinically symptomatic cerebral air embolism secondary to neuro-angiographic procedures is rare, the incidence in a large series of procedures is unknown. Understanding this complication's frequency and etiology is critical if systems are to be instituted to reduce its incidence. METHODS We prospectively reviewed 4,568 consecutive neuro-angiographic procedures performed between June 2000 and July 2005. The occurrence and etiology of a symptomatic air embolus was noted, and an incidence was calculated for all procedures and for diagnostic arteriograms and interventional procedures individually. RESULTS Four symptomatic cerebral arterial air emboli occurred in 4,568 neuro-angiographic procedures over the five-year period (0.08%). No events occurred in 3,150 diagnostic angiograms while four occurred during 1,418 interventional procedures (0.2%). Two cases occurred during aneurysm coiling embolization (2/548; 0.4%); one case occurred during a carotid stent placement (1/138; 0.7%); one occurred during an internal carotid artery balloon occlusion test (1/73; 1.3%). Three of these complications resulted in permanent neurologic deficits while one resulted in a transient neurologic change that cleared within 60 min of onset. Sources for the emboli included the pressurized arterial flush lines connected to internal carotid artery catheters (three cases) and sudden hypotension with air subsequently entering the internal carotid artery catheter (one case). Two patients were treated with hyperbaric oxygen therapy. CONCLUSION Symptomatic cerebral air embolism is a rare event during neuro-angiographic procedures. Analysis of the etiologies of this infrequent event may permit us to further reduce its incidence.
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Affiliation(s)
- Rishi Gupta
- Department of Neurology, Michigan State University, Lansing, MI, USA
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Ors F, Lev-Toaff AS, Bergin D. Echogenic foci mimicking adenomyosis presumably due to air intravasation into the myometrium during sonohysterography. Diagn Interv Radiol 2007; 13:26-9. [PMID: 17354191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To report the radiological findings of a pseudolesion in the myometrium mimicking adenomyosis presumably due to air intravasation during sonohysterography (SHG). MATERIALS AND METHODS We searched magnetic resonance imaging (MRI) and transvaginal ultrasound (TVUS) examination results before and after SHGs, in which echogenic foci were found suggesting adenomyosis in the myometrium, and found 7 female cases. MRI and TVUS findings were compared to the SHG findings to assess the persistence of echogenic foci seen with SHG and other imaging modalities, and to exclude the possibility of pseudolesions secondary to saline-air intravasation into the myometrium during SHG. RESULTS Ages of the 7 patients ranged from 27 to 60 years; 2 of them were postmenopausal. SHG examinations showed solitary or multiple echogenic foci measuring 4-15 mm, with acoustic shadowing, which were adjacent to the endometrium and consistent with adenomyosis. Only 1 of the patients underwent both MRI and TVUS, 2 of them had TVUS after SHG, and 1 had TVUS before SHG; the 3 remaining patients had TVUS as a baseline examination prior to SHG. None of these TVUS or MRI examinations confirmed the echogenic foci found with SHG. CONCLUSION In order to differentiate echogenic myometrial pseudolesions from true adenomyosis lesions, a detailed preliminary TVUS is essential before any SHG procedure. If such lesions are encountered despite meticulous care to avoid the inadvertent introduction of air into the endometrial cavity, TVUS findings should be reviewed and a pelvic MRI is recommended in cases with heterogeneous myometrium.
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Affiliation(s)
- Fatih Ors
- Department of Radiology, Gülhane Military Medical Academy, Ankara, Turkey.
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Adachi YU, Doi M, Sato S. Cardiac arrest by venous air embolism during hepatic resection using the Cavitron Ultrasonic Surgical Aspirator. Anesth Analg 2006; 103:493-4; author reply 494. [PMID: 16861446 DOI: 10.1213/01.ane.0000227065.86465.7f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Koo BN, Kil HK, Choi JS, Kim JY, Chun DH, Hong YW. Hepatic Resection by the Cavitron Ultrasonic Surgical Aspirator?? Increases the Incidence and Severity of Venous Air Embolism. Anesth Analg 2005; 101:966-970. [PMID: 16192503 DOI: 10.1213/01.ane.0000169295.08054.fa] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED The Cavitron Ultrasonic Surgical Aspirator (CUSA) is an innovative tool for resecting hepatic parenchyma, which reduces intraoperative blood loss and perioperative morbidity. We designed this study to compare the incidence and severity of venous air embolism (VAE) detected via transesophageal echocardiography (TEE) during hepatic resection by using either the clamp-crushing method or the CUSA method. Fifty patients scheduled for hepatic resection were randomly assigned to receive hepatic resection by the clamp-crushing method (CC group) or by CUSA (CUSA group). After the induction of anesthesia, the TEE probe was inserted into the patient's esophagus. An independent anesthesiologist graded VAE shown in the 4-chamber view of TEE. All patients in the CUSA group showed VAE during hepatic resection and 44% of the patients had air embolism filling more than half the right heart diameter. In CC group, 68% of the patients showed VAE, which filled less than half the right heart diameter. There were no significant differences in hemodynamics and end-tidal CO2 partial pressure between the two groups. In conclusion, hepatic resection by CUSA increases the incidence and severity of VAE. IMPLICATIONS This study demonstrated that venous air embolism during hepatic resection was more frequent and severe when using the Cavitron Ultrasonic Surgical Aspirator. Although we found no evidence of hemodynamic compromise, increased venous air embolism may increase the risk of paradoxical embolism in patients with liver cirrhosis.
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Affiliation(s)
- Bon N Koo
- *Department of Anesthesia & Pain Medicine and †Anesthesia & Pain Research Institute, ‡Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Kantarci F, Adaletli I, Yalcin G, Selcuk D, Kurugoglu S, Mihmanli I. Lower extremity arterial air embolism secondary to clostridial gas gangrene: diagnosis by Doppler sonography. J Ultrasound Med 2004; 23:1531-1534. [PMID: 15498922 DOI: 10.7863/jum.2004.23.11.1531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Fatih Kantarci
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Kocamustafapasa, 34300 Istanbul, Turkey
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Murphy GS, Szokol JW, Marymont JH, Avram MJ, Vender JS. Retrograde Air Embolization during Routine Radial Artery Catheter Flushing in Adult Cardiac Surgical Patients. Anesthesiology 2004; 101:614-9. [PMID: 15329585 DOI: 10.1097/00000542-200409000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background
Rapid flushing of radial artery catheters may result in retrograde embolization of air into the cerebral circulation. This study examined the incidence of central air embolization during and after flushing of an arterial pressure monitoring system.
Methods
One hundred adult patients undergoing cardiac surgical procedures were enrolled in this study. Ten ml of saline and blood were withdrawn into a syringe in the arterial flushing-sampling pressure system and then readministered to the patient through a 20-gauge radial artery catheter over 3-12 s. The right carotid artery, left carotid artery, and aortic arch were visualized using ultrasound imaging techniques during three manual flushes of the system. The left and right common carotid arteries were examined for the presence of macrobubbles or microbubbles using a linear array ultrasound transducer. The aortic arch was imaged using transesophageal echocardiography to detect retrograde air emboli. The severity of air embolization was quantified using a modification of an established grading system.
Results
A total of 298 ultrasound studies in 100 patients were recorded and analyzed after radial artery catheter flushing. Two aortic arch images were not obtained because of an inability to place the probe. Most clinicians (54%) returned flush solution to patients at near-maximal injection rates (2-3 ml per second). No air emboli (macrobubbles or microbubbles) were detected in the carotid arteries or aortic arch of any subject.
Conclusion
Retrograde air embolization is a rare event after routine radial artery catheter flushing in adult patients with stable hemodynamic conditions.
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Affiliation(s)
- Glenn S Murphy
- Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, Illinois 60201, USA.
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Abu-Omar Y, Balacumaraswami L, Pigott DW, Matthews PM, Taggart DP. Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures. J Thorac Cardiovasc Surg 2004; 127:1759-65. [PMID: 15173734 DOI: 10.1016/j.jtcvs.2003.09.048] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurocognitive dysfunction remains a limitation of cardiac surgery with cardiopulmonary bypass. Intraoperative cerebral microembolization is believed to be one of the most important etiologic factors. Using a new generation of transcranial Doppler ultrasonography, we compared the number and nature of intraoperative microemboli in patients undergoing on-pump and off-pump cardiac surgery procedures. METHODS Bilateral continuous transcranial Doppler monitoring of the middle cerebral arteries was performed in 45 patients (15 off-pump coronary artery bypass grafting, 15 on-pump coronary artery bypass grafting, and 15 open cardiac procedures). All recordings were performed using a multi-range, multifrequency system to allow both measurement of the number and discrimination of the nature of microemboli in the 3 different groups. RESULTS The median number (interquartile range) of microemboli in the off-pump coronary artery bypass grafting, on-pump coronary artery bypass grafting, and open procedure groups were 40 (28-80), 275 (199-472), and 860 (393-1321), respectively (P <.01). Twelve percent of microemboli in the off-pump coronary artery bypass grafting group were solid compared with 28% and 22% in the on-pump coronary artery bypass grafting and open procedure groups, respectively (P <.05). In the on-pump groups, 24% of microemboli occurred during cardiopulmonary bypass, and 56% occurred during aortic manipulation (cannulation, decannulation, application, and removal of crossclamp or sideclamp). CONCLUSIONS Cerebral microembolization is significantly reduced with avoidance of cardiopulmonary bypass. The majority of microemboli occurring during cardiac surgery are gaseous, with a higher proportion of solid microemboli in the on-pump group, and may have a different significance for cerebral injury than solid microemboli. The ability to reliably discriminate gas and solid microemboli may have an important role in the implementation of neuroprotective strategies.
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Affiliation(s)
- Yasir Abu-Omar
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom
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Yildiz S, Ay H, Günay A, Yaygili S, Aktaş S. Submarine escape from depths of 30 and 60 feet: 41,183 training ascents without serious injury. Aviat Space Environ Med 2004; 75:269-71. [PMID: 15018296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION In the case of a submerged, disabled submarine, survivors may be forced to escape by entering the water and ascending rapidly to the surface. The large pressure changes involved may produce pulmonary barotrauma, arterial gas embolism, or barotrauma. To assess the likelihood of such injuries, we retrospectively evaluated medical problems due to submarine escape training among military personnel. METHODS We evaluated 41,183 controlled ascents performed over the past 21 yr in the escape training tank at Gölcük-Kocaeli, Turkey. Each trainee performed two free ascents from 30 ft and two hooded ascents from 60 ft. Before participating, candidates were screened by physical examination, spirometry, and chest X-rays; ear examinations for barotrauma were made after ascents. If a trainee failed to exhale properly during ascent, an instructor aborted the ascent and took him to a bell or side recess of the tank. RESULTS No record of pulmonary barotrauma or other major complications were found. Middle-ear barotrauma was observed following 1,643 of the ascents (4.1%), with rupture of the tympanic membrane in 35 cases. DISCUSSION Submarine escape ascents can be safely performed provided that subjects are medically screened and well trained.
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Affiliation(s)
- Senol Yildiz
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Underwater and Hyperbaric Medicine, Istanbul, Turkey.
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Abstract
Self-Contained Underwater Breathing Apparatus (SCUBA) diving popularity is increasing tremendously, reaching a total of 9 million people in the US during 2001, and 50,000 in the UK in 1985. Over the past 10 years, new advances, equipment improvements, and improved diver education have made SCUBA diving safer and more enjoyable. Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. The four main pathologies in diving medicine include: barotrauma (sinus, otic, and pulmonary); decompression illness (DCI); pulmonary edema and pharmacological; and toxic effects of increased partial pressures of gases. The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. This article reviews some of the principles of diving and pathophysiology of diving injuries as well as the acute treatment, and further management of these patients.
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Abstract
BACKGROUND It is not readily obvious whether an intravascular bubble will grow or shrink in a particular tissue bed. This depends on the constituent gases initially present in the bubble, the surrounding tissue, and the delivered gas admixture. The authors used a computational model based on the physics of gas exchange to predict cerebrovascular embolism behavior during xenon anesthesia. METHODS The authors estimated values of gas transport parameters missing from the literature. The computational model was used with those parameters to predict bubble size over time for a range of temperatures (18 degrees -39 degrees C) used during extracorporeal circulation. RESULTS Bubble size over time is highly nonlinearly dependent on multiple factors, including diffusivity, solubility, gas partial pressures, magnitude of concentration gradients, vessel diameter, and temperature. Xenon- and oxygen-containing bubbles continue to grow during xenon delivery. Bubble volume doubles from 50 to 100 nl in approximately 3-68 min, depending on initial gas composition and bubble shape. Bubble growth and reabsorption are relatively insensitive to temperature in the physiologic and surgical range. CONCLUSIONS Xenon anesthesia results in gas exchange conditions that favor bubble growth, which may worsen neurologic injury from gas embolism. The concentration gradients can be manipulated by discontinuation of xenon delivery to promote reabsorption of xenon-containing bubbles. Estimated growth and reabsorption rates at normothermia can be applied to temperature extremes of cardiopulmonary bypass.
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Affiliation(s)
- Naomi Sta Maria
- Department of Biomedical Engineering, Univeristy of Pennsylvania, Philadelphia, 19104, USA
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Bithal P, Dash HH, Vishnoi N, Chaturvedi A. Venous air embolism: does the site of embolism influence the hemodynamic changes? Neurol India 2003; 51:370-2. [PMID: 14652442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Three hundred and ninety-seven patients undergoing posterior cranial fossa surgery in the sitting position were prospectively studied to evaluate the incidence of venous air embolism (VAE) and its effects on hemodynamics. End-tidal carbon dioxide (ETC02) tension was monitored to diagnose VAE. A sudden and sustained decrease in ETC02 of more than 5 mmHg, in the absence of sudden hypovolemia, was presumed to be the result of VAE. The site of probable air entrainment (whether muscle, bone or tumor) was noted. Hemodynamic consequences were managed symptomatically. ETC02 monitoring detected VAE in 22% of the patients. The highest incidence of embolism resulted from muscles and tumor (40% in each case). Forty-two per cent of patients developed hypotension during the embolic episode (systolic BP less than 100 mmHg). Ten per cent of patients developed ventricular arrhythmias during the embolic episode. Air aspiration was successful in 4.8%. There were no statistically significant differences in the frequency of VAE among the different groups (P>0.05). Also, the frequency of hypotension and ventricular arrhythmias were not significantly different, irrespective of the source of VAE (P>0.05). The general condition of the patients in the preoperative stage had no influence on the incidence of embolism, hypotension or ventricular arrhythmias.
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Affiliation(s)
- P Bithal
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi - 110029, India.
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Nakayama H, Smerz RW. Descriptive epidemiological analysis of diving accidents in Hawaii from 1983 to 2001. Hawaii Med J 2003; 62:165-70. [PMID: 14533348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The Hyperbaric Treatment Center (HTC) at the University of Hawaii, has evaluated and treated over 1100 divers for dysbaric disease from 1983 to 2001. We describe some epidemiological parameters and compare trends between local residents and tourist divers in this article. Data obtained from this review were analyzed for age, gender, type of injury and resident status. While trends in Hawaii have mirrored national figures, we did determine that there were some significant differences between resident and tourist divers' patterns of injury over this period of time.
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Affiliation(s)
- Harumi Nakayama
- UH, Dept. of Physiology, 1960 East-West Rd., Honolulu, HI 96822, USA.
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Scoletta P, Morsiani E, Ferrocci G, Maniscalco P, Pellegrini D, Colognesi A, Azzena G. [Carbon dioxide embolization: is it a complication of laparoscopic cholecystectomy? ]. MINERVA CHIR 2003; 58:313-20. [PMID: 12955049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The occurrence of pulmonary gas embolism in patients undergoing laparoscopic cholecystectomy is reported in the medical literature. Severe intraoperative complications or the patient's death were correlated to gas embolism during laparoscopic procedures. However, the careful retrospective study or the autoptic exam of such casualties have always showed an erroneus direct puncture of vessels or the straight insertion of the Veress needle into a parenchymal organ. It is obvious that the direct gas injection into a vein or into parenchymal organs is a primary cause of gas embolism, as well as the high flow insufflation of gas into the peritoneal cavity in concomitance with the lesion of major abdominal vessel's wall. Gas embolism may occur each time the vein internal pressure is lower than the external pressure and not only during a laparoscopic procedure when carbon dioxyde is inflated into the peritoneal cavity, but also during open surgery such as major liver resections, neurosurgery, vascular or cardiac surgery. The review of large series of laparoscopic cholecystectomies reported in the international literature, as well as our own clinical experience in this field, together with the results of laboratory animal studies based on the experimental insufflation or injection of carbon dioxyde, show that gas embolism must not be considered as a complication of laparoscopic surgery. Due to the above mentioned risks with the use of the Veress needle, the surgeon should revalue alternative means in creating the pneumoperitoneum.
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Affiliation(s)
- P Scoletta
- Sezione di Patologia Chirurgica, Dipartimento di Scienze Chirurgiche Anestesiologiche e Radiologiche, Azienda Ospedaliera Universitaria, Ferrara, Italy
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Shenouda PE, Cunningham BJ. Assessing the superiority of saline versus air for use in the epidural loss of resistance technique: a literature review. Reg Anesth Pain Med 2003; 28:48-53. [PMID: 12567344 DOI: 10.1053/rapm.2003.50009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pamela E Shenouda
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Dunford RG, Vann RD, Gerth WA, Pieper CF, Huggins K, Wacholtz C, Bennett PB. The incidence of venous gas emboli in recreational diving. Undersea Hyperb Med 2002; 29:247-259. [PMID: 12797666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
From 1989-91, the Divers Alert Network monitored recreational divers for Doppler-detected venous gas emboli (VGE) and depth-time profiles following multi-day, repetitive, multi-level exposures. A Spencer score >0 occurred in 61 of 67 subjects (91%) and 205 of 281 dives (73%). No subject developed decompression sickness (DCS) on monitored days although 102 dives (36.3%) scored at Spencer Grades 2 or 3 (High Bubble Grade, HBG). We recorded the depth-time profiles with Suunto dive computers and estimated exposure severity with a probabilistic decompression algorithm. The HBG incidence increased 53% over the range of exposure severity (p < 0.001) in the divers, was approximately 20% higher for repetitive dives than for first dives, and decreased approximately 25% over the 6-8 days of multi-day diving (p < 0.001) suggesting a phenomenon similar to DCS adaptation. The observed HBG incidence was approximately 20% higher for males than females. Older male divers had a 25% increase in observed incidence of HBG while older female divers showed a 55% increase when compared to their younger counterparts.
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Affiliation(s)
- R G Dunford
- Hyperbaric Center, Virginia Mason Medical Center, Seattle, WA, USA
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Tseng M, Sadler D, Wong J, Teague KR, Schemmer DC, Saliken JC, So B, Gray RR. Radiologic placement of central venous catheters: rates of success and immediate complications in 3412 cases. Can Assoc Radiol J 2001; 52:379-84. [PMID: 11780547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To determine the success and immediate complication rates associated with 3412 central venous catheter placements performed in an interventional radiology suite. METHODS Success and immediate complication rates were prospectively recorded for 3412 consecutive patients who had central venous catheters radiologically placed at a tertiary care centre between July 1993 and October 2000. The indication for placement and the insertion site were also recorded. RESULTS The most common indication for both short- and long-term venous access was hemodialysis, and the right internal jugular vein was the most common site for catheter insertion. Placement was successful for 98.8% of tunnelled lines and 99.3% of temporary catheters. The rate for immediate complications (including pneumothorax, air emboli, bleeding and arterial puncture) for tunnelled catheter placements was 3.8% and for temporary catheter placements was 1.6%; no major complications were documented. CONCLUSION Our results lend further evidence to the claim that the success and immediate complication rates of radiologically placed central venous catheters compare favourably with blind placement and surgical placement of central venous catheters.
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Affiliation(s)
- M Tseng
- Department of Diagnostic Imaging, Foothills Hospital, 1403 29th St., NW, Calgary, AB T2N 2T9
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Abstract
From 1992 through 1997, there were 41 deaths by homicidal blunt impact head trauma in Hillsborough County, Florida. Twenty-one cases were excluded from the study because of putrefaction or survival beyond the emergency department doors, leaving 20 cases for the study. One of the 15 nonputrefied victims found dead at the scene and 1 of the 5 victims pronounced dead in the emergency department had definite venous air embolism. Victim 1 was found dead, bludgeoned with a concrete block, and had open vault and comminuted basilar skull fractures. The dura forming the right sigmoid sinus at the jugular foramen was lacerated. A preautopsy chest radiograph and examination under water documented gas in the pulmonary artery and right ventricle. Victim 2 was bludgeoned with a steel stake and was pronounced dead on arrival in the emergency department. He had open comminuted vault fractures, a transverse basilar skull fracture, and lacerations of the brain. Direct examination and preautopsy chest radiography revealed air in the right side of the heart. A third victim, with basilar fractures, had a small gas bubble in the pulmonary artery not detected by the case pathologist. A fourth victim, with a basilar skull fracture, had an unusual radiographic finding that was thought to be air in the posteromedial aspect of the lower lobe of the left lung but could not be excluded as an air embolus. Optimal postmortem documentation of venous air embolism includes the demonstration of the embolus and the site of air ingress. This study demonstrates that venous air embolism occurs in some victims of homicidal bludgeoning and suggests that when significant, it is easily demonstrated in the absence of putrefactive gas formation. The presence of venous air embolism can serve as evidence that a victim was alive and breathing at the time of the infliction of head wounds. In the belief that venous air embolism might be underdiagnosed in many medical examiner offices, the authors have sought to bring attention to the entity by publishing their experience with it in cases of bludgeoning.
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Affiliation(s)
- V Adams
- Department of Pathology and Laboratory Medicine, University of South Florida, Tampa, USA
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Tobias JD, Johnson JO, Jimenez DF, Barone CM, McBride DS. Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants. Anesthesiology 2001; 95:340-2. [PMID: 11506103 DOI: 10.1097/00000542-200108000-00013] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various studies have reported an incidence of venous air embolism (VAE) as high as 82.6% during surgical procedures for craniosynostosis. There has been an increase in the use of minimally invasive, endoseopie surgical procedures, including applications for endoscopic strip craniectomy. The current study prospectively evaluated the incidence of VAF during endoscopic strip craniectomy. METHODS Continuous, intraoperative monitoring for VAE was performed using precordial Doppler monitoring. A recording was made of the Doppler tones and later reviewed to verify its accuracy. RESULTS The cohort for the study included 50 consecutive neonates and infants ranging in age from 3.5 to 36 weeks and ranging in weight from 3 to 9 kg. Surgical time varied from 31 to 95 min for a total of 2,701 mm of operating time, during which precordial Doppler tones were auscultated. In 46 patients, there was no evidence of VAE. In four patients, there was a single episode of VAE. Two of the episodes of VAE were grade I (change in Doppler tones), and two were grade H (change in Doppler tones and decrease in end-tidal carbon dioxide). No grade III (decrease in systolic blood pressure by 20% from baseline) VAF was noted. CONCLUSION In addition to previously reported benefits of decreased blood loss, decreased surgical time, and improved postoperative recovery time, the authors noted a low incidence of VAF during endoscopic strip craniectomy in neonates and infants.
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Affiliation(s)
- J D Tobias
- Department of Anesthesiology, The University of Missouri, Columbia 65212, USA.
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Levy DJ, Child JS, Rambod E, Gharib M, Milo S, Reisner SA. Microbubbles and mitral valve prostheses - transesophageal echocardiographic evaluation. Eur J Ultrasound 1999; 10:31-40. [PMID: 10502637 DOI: 10.1016/s0929-8266(99)00041-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether microbubbles are associated with a specific type of mitral valve prosthesis and to investigate the relationship of microbubbles to ventricular function and mitral regurgitation. One of the types of spontaneous echocardiographic contrast observed in patients with prosthetic heart valves has been described as microbubbles. METHODS Clinical data and videotapes of patients with a prosthetic mitral valve who had undergone transesophageal echocardiography at the UCLA Medical Center between May 1989 and February 1995 were retrospectively reviewed. There were 109 studies (74 patients) available for review by two independent observers. RESULTS Microbubbles occurred in 49 of the 66 studies of St. Jude valves ( 74%), eight of the 12 studies of Bjork Shiley valves (67%), four of four studies of Medtronic valves (100%) and zero of 23 studies of tissue valves (0%). Patients with an estimated ejection fraction greater than 45% were found to have a much higher likelihood of having microbubbles observed. There was no statistically significant association between the degree of mitral regurgitation and the observation of microbubbles. CONCLUSIONS Microbubbles are a common phenomenon occurring in patients with mechanical mitral prostheses compared with tissue mitral valve prostheses. Their formation depends on the systolic ventricular function, suggesting a cavitation-like phenomenon participating in their formation perhaps due to the rate or velocity of the valve closure.
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Affiliation(s)
- D J Levy
- Department of Cardiology, Rambam Medical Center, PO Box 9602, Haifa, Israel
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Arcari M, Phillips SD, Gibbs P, Rela SM, Heaton ND. An investigation into the risk of air embolus during veno-venous bypass in orthotopic liver transplantation. Transplantation 1999; 68:150-2. [PMID: 10428283 DOI: 10.1097/00007890-199907150-00027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After observing micro-bubble activity in the venovenous bypass system during liver transplantation, an experiment was designed to investigate the origin of these bubbles and to define the conditions under which they occurred. Using a Biomedicus constrained vortex pump and a customized circuit design, microbubble activity was measured in saline and blood media during varying pre- and post-head pressures. The data show that air emboli can be generated from this pump and the rate at which they develop is directly related to the pre- and post-head pressure and hematocrit.
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Affiliation(s)
- M Arcari
- Liver Transplant Surgical Service, Kings College Hospital, London, UK
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Abstract
OBJECTIVES To assess whether microbubbles are associated with mitral valve prostheses in children and to investigate their relationship to exercise. BACKGROUND Bright, highly mobile echoes are seen in left heart chambers of patients with mechanical mitral valve prostheses. The clinical importance of those microbubbles is not yet known but they survive long enough to reach the cerebral circulation. No such studies have been reported in children. METHODS There were 20 male and 10 female patients with a mean age of 10.4 years (range 2-16 years). Transthoracic echocardiography with calculation of cardiac output and ejection fraction was performed at baseline and after exercise following mechanical mitral valve replacement. Studies were evaluated for the presence of microbubbles. The mean time from operation to time of study was 18 months (range 0.2-89 months). RESULTS Of the 30 children evaluated, 28 (93%) had evidence of microbubbles. Exercise increased the number of microbubbles in 15 of the 26 children. This was positively associated with an increase in cardiac output. CONCLUSIONS (1) Microbubbles are commonly observed in children with mechanical mitral prostheses and are augmented by exercise. (2) This phenomenon is of a special concern in children due to their expected longevity with the prosthesis.
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Affiliation(s)
- D Levy
- Division of Cardiology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Georgiadis D, Baumgartner RW, Uhlmann F, Lindner A, Zerkowski HR, Zierz S. Venous microemboli in patients with artificial heart valves. Cerebrovasc Dis 1999; 9:238-41. [PMID: 10393412 DOI: 10.1159/000015962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Detection of microemboli signals (MES) in patients with artificial heart valves has been extensively described, but the underlying material remains unclear. We assumed that the detection of MES in the jugular vein of patients with prosthetic valves would clearly argue for gaseous embolic material, since formed emboli are unable to cross through the capillaries. METHODS AND RESULTS Twenty-five patients with artificial heart valves, 15 patients with asymptomatic carotid artery disease, and 25 normal controls were examined. Monitoring was performed simultaneously over the dominant jugular vein and the ipsilateral middle cerebral artery for 30 min per subject, using 2-MHz transducers of a color duplex scanner for the jugular vein and a pulsed-wave Doppler for the middle cerebral artery. Data were harvested in an eight-channel digital recorder and MES counts evaluated by two separate observers. MES prevalence in the middle cerebral artery was 100, 13 and 0% in patients with artificial heart valves, asymptomatic carotid artery disease, and normal controls, respectively. No MES were detected in the jugular veins of patients with carotid artery disease or in normal controls, while their prevalence was 68% in patients with artificial heart valves. The interobserver agreement was satisfactory. CONCLUSION Our results suggest that the embolic material of at least a part of MES in patients with artificial heart valves is gaseous.
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Affiliation(s)
- D Georgiadis
- Department of Neurology, University of Halle, Germany.
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Zhang JX, Peng YK, Zhang BL, Wang CM, Fu HW. [Study on testing method of susceptibility to decompression sickness in aerospace]. Space Med Med Eng (Beijing) 1999; 12:157-60. [PMID: 11766705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objective. To provide related parameters for astronauts. Method. A study of susceptibility to decompression sickness was carried out in 43 subjects in a hypobaric chamber. Result. Incidence of altitude decompression sickness under rest condition was closely related to age, time of oxygen prebreathing, gas bubble formation rates in the venous blood flow returned to heart and some other physiological indexes. Incidence of decompression sickness was significantly higher in subjects aged 30-36 years than in those aged 19-20 years under the same experimental conditions. In the older subjects body-fat, blood cholesterole and noradrenaline in urine during experiment were significantly higher than those in the younger subjects. It also showed that among persons of the same ages, when prebreathing time was longer, the incidence of decompression sickness was significantly lower under the same experimental conditions. Conclusion. It is desirable that the susceptibility to decompression in astronaut be tested with 1 h oxygen prebreathing before exposure to the altitude of 10000 m for 30 min.
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Affiliation(s)
- J X Zhang
- Institute of Space Medico-Engineering, Beijing, China
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Duke DA, Lynch JJ, Harner SG, Faust RJ, Ebersold MJ. Venous air embolism in sitting and supine patients undergoing vestibular schwannoma resection. Neurosurgery 1998; 42:1282-6; discussion 1286-7. [PMID: 9632186 DOI: 10.1097/00006123-199806000-00047] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study retrospectively compares the incidence of venous air embolism (VAE) detection and morbidity in the sitting and supine positions. All patients underwent vestibular schwannoma resection via the retrosigmoid approach by a single surgical team. METHODS A total of 432 consecutive operations were reviewed, 222 of which were performed with the patients in the sitting position and 210 of which were performed with the patients in the supine position. Charts were reviewed for evidence of intraoperative VAE, intraoperative hypotension secondary to VAE, postoperative morbidity related to VAE, and other variables to compare the groups. RESULTS This study demonstrated a 28% incidence of VAE detection when patients were in the sitting position compared to a 5% incidence of VAE detection when patients were in the supine position (P < 0.0001). Intraoperative hypotension secondary to VAE was noted in 1.8% of the sitting patients and 1.4% of the supine patients (P=0.72, no significant difference). Postoperative morbidity caused by VAE was noted in one sitting patient (0.5%) (pulmonary edema) and in no supine patients (P=0.48, no significant difference). Blood loss was slightly greater in the supine group, and operative times were similar in both groups, despite that the average tumor size of patients operated on in the sitting position was 2.8 cm versus 2.2 cm in the supine group (P < 0.0001). CONCLUSION Our results indicate that although there is a higher incidence of VAE detection in sitting patients, the morbidity is not statistically greater. We conclude that because morbidity from VAE is similar in either position, patient positioning should be based on surgical team preference.
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Affiliation(s)
- D A Duke
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Gencbay M, Turan F, Yaymaci B, Degertekin M, Basaran Y, Dindar I, Izgi A. Prevalence of microbubbles associated with mechanical prosthetic cardiac valves: a prospective transesophageal echocardiography study. J Heart Valve Dis 1998; 7:340-4. [PMID: 9651850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to identify the prevalence of microbubbles in different types of mechanical cardiac valve and, if feasible, to associate microbubbles with various clinical conditions, including thrombotic occlusion of the valves. METHODS A total of 153 mechanical prosthetic valves were studied (58 aortic, 95 mitral) in 140 patients, prospectively. All valves were functioning normally. In addition, eight mitral prosthetic valves were selected without microbubbles and with an obstructive valvular thrombosis that had undergone successful thrombolysis (group 1); a further eight patients with unsuccessful thrombolysis (group 2) were studied by transesophageal echocardiography before and after thrombolytic therapy. RESULTS Microbubbles were detected in 75% (114/153) of prosthetic valves, 99% (88/89) of bileaflet valves, and 45% (29/64) of monoleaflet valves (p < 0.0001). Only 14% (4/28) of Sorin monoleaflet valves were associated with microbubbles, which is distinctively less than other valves (p < 0.001 for each); 71% and 77% of aortic and mitral prosthetic valves, respectively, were associated with microbubbles (p = NS). Prosthetic valves with an obstructive thrombosis and no microbubbles in group 1 showed new appearance of microbubbles in 88% (7/8) of cases after successful thrombolysis. Absence of microbubbles in group 2 persisted in all eight patients at the second examination. CONCLUSIONS Microbubbles were detected in a greater proportion of patients than reported previously and were found to be associated more with bileaflet prosthetic heart valves than with monoleaflet valves. Sorin monoleaflet valves were associated with microbubbles dramatically less than all other valves. The new appearance of microbubbles after thrombolytic therapy of mechanical prosthetic heart valves with an obstructive thrombosis may indicate successful thrombolysis.
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Affiliation(s)
- M Gencbay
- Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Georgiadis D, Baumgartner RW, Karatschai R, Lindner A, Zerkowski HR. Further evidence of gaseous embolic material in patients with artificial heart valves. J Thorac Cardiovasc Surg 1998; 115:808-10. [PMID: 9576214 DOI: 10.1016/s0022-5223(98)70359-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We undertook this study to evaluate the hypothesis that most microemboli signals in patients with artificial heart valves are gaseous, assuming that microemboli counts in cerebral arteries would progressively decline with increasing distance from the generating heart valve. METHODS A total of 10 outpatients with CarboMedics (Sulzer Carbomedics Inc., n = 5) and ATS prosthetic heart valves (n = 5) in the aortic (n = 8), mitral (n = 1), or both aortic and mitral positions (n = 1) were recruited. Monitoring was performed simultaneously over the middle and anterior cerebral arteries and the common carotid artery for 30 minutes with the 2 MHZ transducers of a color duplex scanner (common carotid artery) and pulsed-wave Doppler ultrasonography (intracranial arteries). All data were harvested in an eight-channel digital audio tape recorder, and microembolic signal counts were evaluated online by two separate observers. RESULTS Significantly higher microembolic signal counts were recorded in the common carotid artery (112 [75 to 175]) compared with the middle and anterior cerebral arteries (30 [18 to 36], p < 0.0001). Interobserver variability was satisfactory (k = 0.81). CONCLUSIONS Our results strongly argue for gaseous underlying embolic material in patients with artificial heart valves because bubbles are bound to implode with time.
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Affiliation(s)
- D Georgiadis
- Department of Neurology, University of Halle, Germany
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Abstract
Formation and subsequent evolution of gas bubbles in blood and tissues of subjects exposed to decompression are casual processes in their nature. Such character of bubbling processes in a body predetermines probabilistic character of decompression sickness (DCS) incidence in divers, aviators and astronauts. Our original probabilistic theory of decompression safety is based on stochastic models of these processes and on the concept of critical volume of a free gas phase in body tissues. From positions of this theory, the probability of DCS incidence during single-stage decompressions and during hypobaric decompressions under EVA in particular, is defined by the distribution of possible values of nucleation efficiency in "pain" tissues and by its critical significance depended on the parameters of a concrete decompression. In the present study the following is shown: 1) the dimensionless index of critical nucleation efficiency for "pain" body tissues is a more adequate index of decompression stress in comparison with Tissue Ratio, TR; 2) a priory the decompression under EVA performed according to the Russian protocol is more safe than decompression under EVA performed in accordance with the U.S. protocol; 3) the Russian space suit operated at a higher pressure and having a higher "rigidity" induces a stronger inhibition of mechanisms of cavitation and gas bubbles formation in tissues of a subject located in it, and by that provides a more considerable reduction of the DCS risk during real EVA performance.
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Affiliation(s)
- V P Nikolaev
- Institute of Biomedical Problems, Moscow, Russia
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49
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Abstract
Four outbreaks of gas bubble disease were encountered among farmed fish in Saudi Arabia. Two of them occurred among subadult (52.5 g) saltwater tilapia (Oreochromis spilurus), the first affecting about 50 per cent of the stock and resulting in about 30 per cent mortality, and the second affecting about 25 per cent of the population with about 5 per cent mortality. Another outbreak occurred among adult (270 g) brackish water (0.5 per cent salinity) tilapia (Oreochromis niloticus), affecting about 40 per cent of the population with about 25 per cent mortality. The fourth outbreak occurred among three-month-old (15 g) grouper (Epinephelus fuscogutiatus) and resulted in 10 per cent mortality. In all cases the total water gas pressure ranged between 111.2 and 113.4 per cent saturation and nitrogen was supersaturated while oxygen was undersaturated. The outbreaks were alleviated by reducing the gas pressure by splashing the source water or by switching to a source of water with lower gas pressure. However, in O niloticus the conditions of gas supersaturation resulted in a heavy infection by monogenetic trematodes which was treated with formalin at 40 mg/litre for seven hours on five successive days.
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Affiliation(s)
- M O Saeed
- Fish Farming Center, Ministry of Agriculture and Water, Jeddah, Saudi Arabia
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50
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Bove AA. Patent foramen ovale and decompression illness--reply. SPUMS J 1997; 27:84. [PMID: 11540579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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