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1.
Medicine (Baltimore) ; 99(3): e18595, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011438

RESUMO

INTRODUCTION: Acute pulmonary embolism (APE) during an operation is a very urgent occurrence, especially when the patient with hemodynamic instability. Generally, drugs are administered intravenously; however, these drugs have little effects under most circumstances. We present a case of successful resuscitation in a patient with endotracheal administration. PATIENT CONCERNS: A 67-year-old female presented for laparoscopic hepatectomy. Acute pulmonary gas embolism occurred during the operation with hemodynamic instability. The total amount of carbon dioxide and argon reached 300 mL. We used a novel way of administering drugs instead of intravenous administration for rescuing and the patient condition had improved greatly and was discharged from the hospital without any neurological deficits. DIAGNOSES: A diagnosis of APE was made because of a lot of gas was extracted out from central venous catheter and sudden observable decrease in end-tidal CO2. INTERVENTIONS: These measures included endotracheal administration, position adjustment, manual ventilation, and gas extraction. OUTCOMES: The patient was discharged from the hospital and had no signs of neurological deficits. CONCLUSION: Intravenous administration may not the best appropriate way of administration when patients occurred APE. Endotracheal administration as a unique method may work wonders and has the value of research and application.


Assuntos
Embolia Aérea/etiologia , Embolia Aérea/terapia , Hepatectomia/efeitos adversos , Laparoscopia/efeitos adversos , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Idoso , Feminino , Humanos
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1110-1114, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874524

RESUMO

Carbon dioxide embolization is a special complication of laparoscopic colorectal surgery. It is rarely reported in conventional laparoscopic colorectal surgery, and has not been well recognized by surgeons. Transanal total mesorectal excision (taTME) is an increasingly popular sphincter-preserving surgery for low rectal cancer in recent years. Although the number of cases worldwide is not large, carbon dioxide embolization after operation has been reported successively. Once serious carbon dioxide embolization occurs, the mortality is extremely high. The main related factors of carbon dioxide embolization in taTME include high pressure of pneumoperitoneum, narrow space, abundant blood supply of prostate and vaginal wall, Trendelenburg position, etc. The key of prevention and treatment is to pay attention to the control of related risk factors, identify the early signs of carbon dioxide embolism, and take active and effective symptomatic treatment. Reducing the pressure of pneumoperitoneum perfusion can reduce the occurrence of CO2 embolism. Transesophageal echocardiography is the most sensitive way to monitor intravenously CO2, but it is difficult to carry out in clinical practice. The sudden decrease of end expiratory CO2 partial pressure is an important sign of early detection of CO2 embolism. If there is a suspicious lacuna in the operation, it is possible to reduce or stop the pneumoperitoneum when it is unable to distinguish between normal tissue gap or vascular lumen. If the "bubble sign" is observed, CO2 may enter the vein. The risk of venous embolism should be considered.


Assuntos
Dióxido de Carbono/efeitos adversos , Embolia Aérea/prevenção & controle , Laparoscopia/efeitos adversos , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/efeitos adversos , Canal Anal/cirurgia , Embolia Aérea/etiologia , Embolia Aérea/terapia , Feminino , Humanos , Masculino , Mesentério/cirurgia , Reto/cirurgia
3.
Undersea Hyperb Med ; 46(5): 673-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683367

RESUMO

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.


Assuntos
Embolia Aérea/terapia , Oxigenação Hiperbárica/métodos , Algoritmos , Altitude , Artérias , Pressão Atmosférica , Descompressão/efeitos adversos , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Forame Oval Patente/complicações , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Posicionamento do Paciente/métodos , Veias
4.
J Stroke Cerebrovasc Dis ; 28(12): 104403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563566

RESUMO

BACKGROUND: Air embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated. METHODS: We conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD. RESULTS: Given the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement. CONCLUSIONS: Despite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.


Assuntos
Embolia Aérea , Endoscopia Gastrointestinal/efeitos adversos , Embolia Intracraniana , Idoso , Idoso de 80 Anos ou mais , Embolia Aérea/epidemiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/prevenção & controle , Embolia Aérea/terapia , Feminino , Humanos , Oxigenação Hiperbárica , Incidência , Infusões Parenterais , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/prevenção & controle , Embolia Intracraniana/terapia , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/administração & dosagem , Medição de Risco , Fatores de Risco , Resultado do Tratamento
5.
Mo Med ; 116(3): 180-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527936

RESUMO

Emergent indications for HBO2 are not only for some of the most serious conditions, but also may be the only modality to directly target the patient's pathophysiology. They are to begin emergently or urgently, but may be limited by either the instability of the patient's condition or transfer logistics. Often these emergent treatments involve several treatments in the first 24 hours for best outcomes. If one considers the effects of HBO2 upon the body while breathing 100% oxygen at pressure many benefits become evident. This article will concisely review hyperbaric oxygen's emergent indications.


Assuntos
Embolia Aérea/terapia , Emergências , Oxigenação Hiperbárica , Embolia Aérea/sangue , Embolia Aérea/etiologia , Humanos
6.
Chin J Traumatol ; 22(5): 308-310, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31371236

RESUMO

Systemic air embolism is a rare but potentially fatal complication related to many factors. The purpose of this article is to alert clinicians once patients occurs an abnormal neurological and cardiovascular status, following minor traumatic treatment, air embolism should be considered. A 20-year-old man who presented with fungal pneumonia with lung cavities formation was admitted to an intensive care unit (ICU) and received positive airway pressure ventilation. Four days later, the fungal pneumonia was improved, but the patient's blood pressure and arterial oxygen saturation deteriorated, so computed tomography (CT) scans were preformed to reevaluate him. The scans detected air embolism in the left atrium and ventricle, ascending aorta, aortic arch and its branches (right brachiocephalic, bilateral common carotid and right subclavian arteries), descending aorta and right coronary artery. A CT scan of the abdomen revealed air in the spleen, cauda pancreatic, superior mesenteric artery and right external iliac artery. The patient died two days later from multiple organ dysfunction. We suggest that vascular air embolism should be considered under mechanical ventilation when patients' neurologic and cardiovascular status deteriorates, and hyperbaric oxygen therapy should be conducted immediately.


Assuntos
Embolia Aérea/etiologia , Pneumopatias Fúngicas/complicações , Respiração com Pressão Positiva/efeitos adversos , Adulto , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/terapia , Evolução Fatal , Humanos , Oxigenação Hiperbárica , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/patologia , Pneumopatias Fúngicas/terapia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Eur J Radiol ; 117: 26-32, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307649

RESUMO

OBJECTIVES: To evaluate the incidence and risk factors of systemic air embolism (SAE) depicted on systematic whole thoracic CT performed after percutaneous lung biopsy. METHODS: A total of 559 CT-guided lung biopsies performed between April 2014 and May 2016 were retrospectively evaluated. SAE was defined by the presence of air in the aorta or left cardiac cavities seen on whole thorax CT images acquired after needle withdrawal. Analyzed data focused on patient (age, sex, spirometry data, emphysema on CT, therapeutics received), target lesion (location, depth, size and feature) and procedure (patient position, length of intrapulmonary needle path, number of pleural passes and of biopsy samples, operator's experience). A regression logistic model was used to identify risk factors of SAE. RESULTS: SAE was observed after 27 of the 559 lung biopsies, corresponding to a radiological incidence of 4.8% (95%CI: 3.3-7.0). Clinical incidence was 0.17% (n = 1). For 21/27 patients (78%), a targeted acquisition in the nodule area would not have included the cardiac cavities meaning SAE would have been missed. On multivariate analysis, the independent risk factors were needle path length through ventilated lung (OR: 1.13, 95%CI: 1.02-1.25, p = 0.024), number of samples (OR: 1.48, 95%CI: 1.01-2.17, p = 0.046) and prone position (OR: 3.12, 95%CI: 1.11-8.31, p = 0.031) or right-sided lateral decubitus (OR: 6.15, 95%CI: 1.66-22.85, p = 0.005). CONCLUSIONS: Asymptomatic systemic air embolism can be depicted in almost 5% of post biopsy CT examinations, when they are not limited to the targeted nodule area but include the entire thorax.


Assuntos
Biópsia por Agulha/efeitos adversos , Embolia Aérea/etiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Idoso , Biópsia por Agulha/métodos , Embolia Aérea/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
8.
Dis Colon Rectum ; 62(7): 794-801, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188179

RESUMO

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links.lww.com/DCR/A961.


Assuntos
Embolia Aérea/etiologia , Hemorragia/complicações , Insuflação/efeitos adversos , Complicações Intraoperatórias/etiologia , Reto/cirurgia , Cirurgia Endoscópica Transanal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono , Embolia Aérea/diagnóstico , Embolia Aérea/terapia , Feminino , Humanos , Insuflação/métodos , Internacionalidade , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cuidados Pós-Operatórios , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Veias
10.
Medicine (Baltimore) ; 98(18): e15437, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045810

RESUMO

RATIONALE: Cranial arterial air embolism is a rare but potentially fatal complication after computed tomography (CT)-guided pulmonary interventions. PATIENT CONCERNS: A 64-year-old man was diagnosed with a pulmonary nodule (diameter: approximately 1 cm) in the right lower lobe. The patient developed convulsions after CT-guided hook-wire localization. DIAGNOSIS: Cranial CT revealed arborizing/linearly distributed gas in the territory of the right middle cerebral artery. INTERVENTIONS: The patient was administered hyperbaric oxygen, antiplatelet aggregation therapy, and dehydration treatment. OUTCOMES: Clinical death occurred 55 hours after air embolism. LESSONS: Systemic air embolism is a serious complication of lung puncture. Clinicians should improve their understanding of this complication and remain vigilant against air embolism.


Assuntos
Doenças Arteriais Cerebrais/etiologia , Embolia Aérea/etiologia , Radiografia Intervencionista/efeitos adversos , Nódulo Pulmonar Solitário/cirurgia , Doenças Arteriais Cerebrais/terapia , Embolia Aérea/terapia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Radiografia Intervencionista/métodos
11.
Undersea Hyperb Med ; 46(2): 197-202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051065

RESUMO

We present the case of a 42-year-old female who was critically ill due to an arterial gas embolism (AGE) she experienced while diving in Maui, Hawaii. She presented with shortness of breath and dizziness shortly after surfacing from a scuba dive and then rapidly lost consciousness. The diver then had a complicated hospital course: persistent hypoxemia (likely secondary to aspiration) requiring intubation; markedly elevated creatine kinase; atrial fibrillation requiring cardioversion; and slow neurologic improvement. She had encountered significant delay in treatment due to lack of availability of local hyperbaric oxygen (HBO2) therapy. Our case illustrates many of the complications that can occur when a patient suffers a severe AGE. These cases may occur even without a history of rapid ascent or risk factors for pulmonary barotrauma, and it is imperative that they be recognized and treated as quickly as possible with HBO2. Unfortunately, our case also highlights the challenges in treating critically ill divers, particularly with the growing shortage of 24/7 hyperbaric chambers able to treat these ICU-level patients.


Assuntos
Mergulho/efeitos adversos , Embolia Aérea/terapia , Oxigenação Hiperbárica , Tempo para o Tratamento , Adulto , Diagnóstico Tardio/efeitos adversos , Embolia Aérea/etiologia , Emergências , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia
12.
Diving Hyperb Med ; 49(1): 61-63, 2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30856669

RESUMO

INTRODUCTION: Portal venous gas from a diving injury is an infrequent finding and only a few cases are described. We report a case of severe decompression sickness (DCS) associated with a massive amount of gas in the portal and mesenteric veins. CASE REPORT: A 49-year-old man suffered from DCS after two deep dives on the same day. He presented with cutaneous, neurological and pulmonary symptoms associated with hypoxaemia. He had no abdominal pain. A computed tomography (CT) scan showed large quantities of hepatic and portal venous gas and excluded other explanations for its presence. All symptoms disappeared with hyperbaric oxygen therapy and there were no further complications. DISCUSSION AND CONCLUSION: The role of portal venous gas in DCS is not obvious. Isolated portal venous gas seems to cause no obvious harm. Medical imaging should be considered for differential diagnosis and to prevent some complications, especially in divers presenting with abdominal pain.


Assuntos
Doença da Descompressão , Mergulho , Embolia Aérea , Oxigenação Hiperbárica , Doença da Descompressão/diagnóstico , Doença da Descompressão/terapia , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/terapia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Veia Porta
14.
J Cardiothorac Surg ; 14(1): 12, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30654802

RESUMO

BACKGROUND: Arterial air embolism during open heart surgery may cause postoperative complications including cerebral injury, myocardial dysfunction, and dysrhythmias. Despite standard de-airing techniques during surgery large amounts of arterial air emboli may still occur, especially during weaning from cardiopulmonary bypass. To prevent this insufflation of carbon dioxide in the wound cavity has been used since the 1950s. The aim of this study was to assess a new mini-diffuser for efficient carbon dioxide de-airing of a minimal invasive cardiothoracic wound cavity model. Up until now no device has been evaluated for this purpose. METHODS: A new insufflation device, a mini-diffuser, was tested. A thin plastic tube was used as control. The end of the mini-diffuser or the control, respectively, was positioned in a minimal invasive thoracic wound model. Remaining air content was measured during steady state and during intermittent suction with a rough suction device at different carbon dioxide flow rates. Measurements were also carried out in the open surgical wound during minimal invasive aortic surgery in six patients. RESULTS: The air content was below 1% 4 cm below the surface of the open wound model during continuous carbon dioxide inflow of 2-10 L/min with the mini diffuser. In comparison, carbon dioxide insufflation via the open-ended tube resulted in a mean air content between 10 and 75%. The mean air content of the wound model remained below 1% at a carbon dioxide flow rate of 3-5 L/min during intermittent application of a suction device with a suction rate of 15 L/min. In 6 patients undergoing minimal invasive aortic valve replacement air content in the open surgical wound remained below 1% at a continuous carbon dioxide flow rate of 5 and 8 L/min via the mini-diffuser, respectively. CONCLUSIONS: The mini diffuser was effective for carbon dioxide de-airing, i.e. < 1% remaining air, of a minimal invasive cardiothoracic wound cavity model with and without intermittent rough suction as well as in patients undergoing minimal invasive aortic valve surgery.


Assuntos
Dióxido de Carbono/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Embolia Aérea/terapia , Insuflação/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Embolia Aérea/etiologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Cardiovasc Intervent Radiol ; 42(1): 150-153, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30109408

RESUMO

Systemic artery embolism is a rare complication of CT-guided lung biopsy. Immediate clinical and radiological recognitions are crucial for rapid intervention and prevention of fatal outcome. Although hyperbaric oxygen is the suggested treatment of mildly symptomatic systemic artery embolization, aspiration of air should be considered as part of the management in cases of cardiac arrest.


Assuntos
Embolia Aérea/etiologia , Parada Cardíaca/etiologia , Pulmão/patologia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Biópsia por Agulha/efeitos adversos , Embolia Aérea/terapia , Parada Cardíaca/terapia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sucção
16.
Pacing Clin Electrophysiol ; 42(1): 104-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30156304

RESUMO

Cerebral air embolism is a potentially life-threatening complication of left-sided ablation procedures. We present a 51-year-old woman with cerebral air embolism during atrial fibrillation cryoballoon ablation. Taking a deep breath while removing the dilatator was the most likely mechanism in our case. The patient was successfully treated with hyperbaric oxygen therapy at early stage and was discharged without any neurological sequelae.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Embolia Aérea/etiologia , Embolia Aérea/terapia , Oxigenação Hiperbárica , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Feminino , Humanos , Pessoa de Meia-Idade
17.
Clin Imaging ; 53: 49-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30312855

RESUMO

PURPOSE: We presented details and incidence of systemic arterial embolism (SAE) following a CT-guided percutaneous transthoracic needle biopsy (PTNB) and evaluated risk factors for SAEs. METHODS: We retrospectively evaluated 1014 PTNBs performed in our hospital from 2005 to 2017. SAE was identified in the pulmonary vein, left heart, coronary artery, and aorta by reviewing post-biopsy CT images. Limited post-biopsy CT scans only covering the region biopsied were available until the first case of SAE was identified (n = 503). Then, the entire thorax was scanned for further examination of SAE (n = 511). Eighteen-gauge automatic cutting needles were used in all procedures. When SAE was evident on post-biopsy CT, subsequent brain CT was performed in order to confirm the cerebral SAE. RESULTS: Nine patients (0.89%) developed SAEs. In the univariate analyses, the location of the needle tip relative to the lesion (outside or inside of the lesion) as well as accompanying pulmonary hemorrhage were significant risk factors for SAEs (P = 0.021 and 0.036, respectively). Two patients developed neurological symptoms with cerebral SAEs, and one of these had sequelae. In seven asymptomatic SAEs with no cerebral SAE, four patients were retrospectively-diagnosed cases and three patients were detected on post-biopsy CT images. All seven of these patients had no sequelae. CONCLUSION: The incidence of SAE was higher than expected, due to radiologically detected asymptomatic SAEs. The location of the needle tip relative to the lesion and accompanying pulmonary hemorrhage were significant risk factors for the occurrence of SAEs. We proposed a guideline for treating asymptomatic SAEs.


Assuntos
Biópsia por Agulha/efeitos adversos , Embolia Aérea/etiologia , Agulhas/efeitos adversos , Tórax , Idoso , Aorta , Encéfalo/patologia , Vasos Coronários , Embolia Aérea/terapia , Feminino , Coração , Hemorragia/etiologia , Humanos , Biópsia Guiada por Imagem/métodos , Incidência , Pulmão/patologia , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Miocárdio , Veias Pulmonares , Radiografia Intervencionista/métodos , Radiologia , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
18.
Semin Cardiothorac Vasc Anesth ; 23(3): 324-332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30589392

RESUMO

Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.


Assuntos
Ponte Cardiopulmonar/métodos , Embolia Aérea/terapia , Embolia Intracraniana/terapia , Embolia Aérea/diagnóstico por imagem , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/terapia , Monitorização Intraoperatória/métodos , Neuroproteção , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adulto Jovem
19.
Acta Anaesthesiol Scand ; 63(2): 154-160, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30203491

RESUMO

BACKGROUND: Cerebral gas embolism is a complication of several medical procedures and occurs when gas enters the cerebral circulation. Knowledge about etiology and outcome in affected patients is limited, and prospective trials on management and treatment are hardly feasible. Case reports are therefore an important source of information. METHODS: A systematic literature search was conducted in June 2016 and May 2018, supplemented by a manual search. Titles and abstracts were systematically assessed for eligibility, followed by full-text screening for included papers. Screening and data extraction were performed independently by two researchers. Cases of cerebral gas embolism due to any iatrogenic cause were included. Criteria for exclusion were: animal studies, non-cerebral localization, extravascular gas only, and non-iatrogenic causes. 264 cases reported in 189 papers were included. RESULTS: A broad range of procedures leading to iatrogenic cerebral gas embolism (ICGE) were identified and a comprehensive list is presented in this article. Procedures were mostly reported as conducted correctly, but procedure related error, patient activity, or defective equipment were also reported as causes. Neurological, neuropsychological, and cardiopulmonary symptoms were common. The diagnosis was frequently based on or confirmed by radiology, usually CT. Hyperbaric oxygen therapy was applied in a large number of cases. CONCLUSION: The reported causes, symptoms and signs, and outcomes of ICGE vary significantly, and awareness of the condition in the medical community is essential. A standardized method of reporting could facilitate higher quality research in the field.


Assuntos
Embolia Aérea/terapia , Doença Iatrogênica , Embolia Aérea/epidemiologia , Embolia Aérea/etiologia , Humanos , Período Perioperatório , Resultado do Tratamento
20.
J Neurosurg Anesthesiol ; 31(4): 413-421, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30148744

RESUMO

BACKGROUND: Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. METHODS: Patients undergoing a neurosurgical procedure in the seated position at a single institution between January 2000 and October 2013 were identified. Corresponding medical records, neurosurgical operative reports, and computerized anesthetic records were searched for intraoperative VAE diagnosis. Extreme VAE was defined as a case in which urgent seated to level position change was performed for patient safety. Detailed examples of extreme VAE cases are described, including their intraoperative course, VAE management, and postoperative outcomes. RESULTS: There were 8 extreme VAE (0.47% incidence), 6 during suboccipital craniotomy (1.5%) and 2 during deep brain stimulator implantation (0.6%). VAE-associated end-expired CO2 and mean arterial pressure reductions rapidly normalized following position change. No new neurological deficits or cardiac events associated with extreme VAE were observed. In 5 of 8, surgery was completed. Central venous catheter placement and aspiration during VAE played no demonstrable role in patient outcome. CONCLUSIONS: Extreme VAE during seated intracranial neurosurgical procedures is infrequent. Extreme VAE-associated CO2 exchange and hemodynamic consequences from VAE were transient, recovering quickly back to baseline without significant neurological or cardiopulmonary morbidity.


Assuntos
Embolia Aérea/epidemiologia , Complicações Intraoperatórias/epidemiologia , Procedimentos Neurocirúrgicos/métodos , Posicionamento do Paciente , Adulto , Idoso , Anestesia , Neoplasias Encefálicas/cirurgia , Estudos de Coortes , Craniotomia , Embolia Aérea/etiologia , Embolia Aérea/terapia , Feminino , Humanos , Incidência , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Estudos Retrospectivos , Postura Sentada , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento
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