AIR EMBOLISM - keywords
air embolism
CUS
scheme
air microbubble ----> ischaemia and endothelial compression ----> neuronal injury
r
e
f
e
r
e
n
c
e
s
manipulation
after Muth et al. 2000
n
a
v
i
g
a
t
o
r
>
pneumatosis
<
air embolism
Muth CM, Shank ES. Gas embolism. N Engl J Med. 2000 Feb 17;342(7):476-82.
Bubble Obstructing End-Arterial Flow in a Cerebral Vessel with a Diameter of 30 to 60 μm, Causing Distal Ischemia. The obstruction causes the metabolic processes of neurons to fail. Sodium and water enter the vessel, and cytotoxic edema develops. The surface of the bubble generates a foreign-body response through cellular and humoral immune mechanisms. The bubble also mechanically irritates the arterial endothelium. Both processes result in vasogenic edema and greater impairment of perfusion. The neuronal injury extends beyond the area of obstruction.
Al-Hathlol K, Al-Mane K, Al-Hathal M, Al-Tawil K, Abulaimoun B. Air emboli in the intracranial venous sinuses of neonates. Am J Perinatol. 2002 Jan;19(1):55-8.
Air bubbles in the intracranial venous sinuses are known as a consequence to different causes including trauma, infection, and administration of intravenous contrast. Most of the previous reports demonstrated such cases in adults, with subsequent complications. We are presenting two premature babies who developed asymptomatic air bubbles in the right cavernous and left transverse sinuses, introduced accidentally upon cannulation of scalp veins. In both babies the air embolism disappeared in a few days without complications. Our cases suggest that these accidents could happen more frequently in neonates following scalp vein cannulation, which is a common procedure in sick babies, but they were overlooked as the outcome was uneventful. However, the precise nature and clinical significance of this lesion is not well understood in neonates.
Fortrat JO, Saumet M, Savagner C, Leblanc M, Bouderlique C. Bubbles in the brain veins as a complication of daily management of a scalp vein catheter. Am J Perinatol. 2005 Oct;22(7):361-3.
Recently, it has been suspected that venous dural sinus air embolisms could occur as a result of scalp vein infusion. The possible mechanism for this complication has not been documented to date, and procedures to avoid venous dural sinus air embolism have not been presented. We report a preterm neonate who demonstrated venous dural sinus air embolism following daily management of a scalp vein catheter. The air embolism disappeared in a few days without complications. Clinicians should avoid injecting air into a scalp vein catheter and leaving it open to air. Following careful examination and review of the infant's case, we were able to conclude that positioning the infant in either supine or Trendelenburg position during daily management of scalp venous infusions and using an air-occlusive dressing once the catheter is removed could limit the risk of venous dural sinus air embolisms caused by scalp vein infusions.
Taylor SP, Hoffman GM. Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant. Can J Anaesth. 2010 Aug;57(8):774-8.
High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufflation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufflation of laparoscopic gas resulted in immediate cardiovascular collapse requiring prolonged resuscitation. Persistent intracranial emboli following the arrest may have resulted from nitrogen contamination of the delivered gas.
A 12-day-old female underwent laparoscopy for pyloric stenosis. During initial insufflation of the abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide (CO(2ET)) associated with bradycardia and pulseless electrical activity. Three hours after successful resuscitation and open pyloromyotomy, computerized tomography documented intra-arterial gas within the cerebral and hepatic circulations that resolved following hyperbaric oxygen therapy. Magnetic resonance imaging five days later revealed watershed infarcts in the right frontal and parietal regions. Nitrogen, an insoluble gas not easily eliminated from the body, was likely the gas present within the patient's circulation several hours after the event. It was unlikely carbon dioxide, which is a highly soluble gas that binds to hemoglobin and is rapidly buffered by the carbonic anhydrase system and excreted by the lung. Room air contamination of high volume insufflation tubing allows nitrogen to enter body cavities during endoscopic procedures.
Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures.
Muneuchi J, Kuraoka A, Ochiai Y, Nishibatake M, Sese A, Joo K. Fatal systemic air embolism in a neonate with absent aortic valve. Pediatr Cardiol. 2011 Aug;32(6):839-41.
A 32-year-old pregnant woman was referred at 33 weeks' gestation for prenatal ultrasound demonstrating fetal hydrops due to absent aortic valve with free aortic valve insufficiency. Elective caesarian section at 34 week's gestation was performed. Surgical intervention was planned immediately after labor at which time mitral valve closure and atrial septostomy using cardiopulmonary bypass would be performed. However, before insertion of the cannula for cardiopulmonary bypass, a gush of air from the right atrium was noted. The surgical procedure was abandoned because systemic air embolism was suspected. The child died 2 h after birth. Autopsy showed absent aortic valve with closed foramen ovale and left-ventricular hypertrophy. Microscopic findings showed pulmonary and systemic lymphangiectasis, which caused the introduction of air into systemic venous system by way of lymphatic duct just after birth.
Mac OS X 2ÖATTRÜ,Ücom.apple.TextEncodingë com.apple.provenanceöcom.apple.quarantineutf-8;134217984Â. Im0ÖWq/0081;00000000;;