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Incidence of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography.
Afreen, Lubana K; Bryant, Ayesha S; Nakayama, Tetsuzo; Ness, Timothy J; Jones, Keith A; Morgan, Charity J; Wilcox, Charles M; Phillips, Mark C.
Afiliação
  • Afreen LK; From the Departments of Anesthesiology and Perioperative Medicine.
  • Bryant AS; From the Departments of Anesthesiology and Perioperative Medicine.
  • Nakayama T; From the Departments of Anesthesiology and Perioperative Medicine.
  • Ness TJ; From the Departments of Anesthesiology and Perioperative Medicine.
  • Jones KA; From the Departments of Anesthesiology and Perioperative Medicine.
  • Morgan CJ; Biostatistics.
  • Wilcox CM; Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama.
  • Phillips MC; From the Departments of Anesthesiology and Perioperative Medicine.
Anesth Analg ; 127(2): 420-423, 2018 08.
Article em En | MEDLINE | ID: mdl-29933275
ABSTRACT

BACKGROUND:

Known complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, bleeding, duodenal perforation, and venous air embolism (VAE). The aim of this study was to determine the incidence of VAE during ERCP and be able to differentiate high-risk versus low-risk ERCP procedures.

METHODS:

This is a prospective cohort study consisting of patients who underwent ERCP and were monitored with a precordial Doppler ultrasound (PDU) for VAE. PDU monitoring was digitally recorded and analyzed to confirm the suspected VAE. Demographic and clinical data related to the anesthetic care, endoscopic procedure, and intraoperative hemodynamics were analyzed.

RESULTS:

A total of 843 ERCP procedures were performed over a 15-month period. The incidence of VAE was 2.4% (20 patients). All VAE's occurred during procedures in which stent placement, sphincterotomy, biopsy, duct dilation, gallstone retrieval, cholangioscopy, or necrosectomy occurred. Ten of 20 (50%) of VAEs were associated with hemodynamic alterations. None occurred if the procedure was only diagnostic or for stent removal. Subanalysis for the type of procedure showed that VAE was statistically more frequent when stents were removed and then replaced or if a cholangioscopy was performed.

CONCLUSIONS:

The high incidence of VAE highlights the need for practitioners to be aware of this potentially serious event. Use of PDU can aid in the detection of VAE during ERCP and should be considered especially during high-risk therapeutic procedures. Detection may allow appropriate interventions before serious adverse events such as cardiovascular collapse occur.
Assuntos

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Colangiopancreatografia Retrógrada Endoscópica / Embolia Aérea Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Anesth Analg Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Colangiopancreatografia Retrógrada Endoscópica / Embolia Aérea Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Anesth Analg Ano de publicação: 2018 Tipo de documento: Article