Simple handling of venous air embolism during abdominal myomectomy

Abstract

We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment.

Venous Gas Embolism During Radical Robotic Prostatectomy: A Case Report and Evidence-Based Management Algorithm

“…Maneuvers that encourage the release of the air from the right ventricular outflow tract are debatable [ 19 ] but still recommended [ 8 , 17 , 41 ]. These maneuvers, most notably the Trendelenburg or Durant maneuver (Trendelenburg plus partial left lateral decubitus position), were reported in 69% of case reports reviewed and were considered in most review articles [ 9 , 14 , 17 , 18 , 20 , 23 , 24 , 28 , 29 , 33 , 35 , 37 - 39 , 42 , 43 ].…”

“…Current recommendations are strongest for its use in hemodynamically unstable patients who have a catheter in situ and are refractory to other management interventions [ 8 , 9 , 17 ]. This review found that 39% of case reports attempted to aspirate the right atrium for air; successful aspirations also note the beneficial diagnostic ability of this procedure [ 23 , 25 , 28 - 30 , 34 , 37 , 44 , 45 ]. Figure 3 compiles our results in a patient care algorithm.…”

“…For prostatectomies, the vascular-rich envelopment of the prostate increases the level of risk even with the minimally invasive RARP approach [16] with one study reporting 100% of subclinical embolic events during RARP occurring during transection of the deep dorsal venous complex [12]. The most commonly reported risk factor, gas insufflation, was mentioned in 73% of the case reports reviewed [6,7,9,[17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The schematic in Figure 1 highlights several of these risks.…”

“…Auscultation of a "mill-wheel" murmurs over the precordium rules in VAE [18]. Even with these options, these technologies used as a tool for VAE detection were referenced in 47% of case reports [9,14,[23][24][25][26][27][28][29][30][31].…”

Venous air embolism: An under-recognised entity in blunt-force trauma and the importance of radiology

“…11 However, arterial air emboli can occur due to pulmonary lacerations or barotrauma, with air travelling to the coronary arteries or cerebral arteries. 2 Common causes of AE in the medico-legal setting can include surgical 12,13 and therapeutic procedures such as intravenous infusion, 3 or during percutaneous transthoracic needle biopsy, 14 criminal abortion, 15 dysbaric barotrauma seen in scuba divers 16 and blunt-force injury to the head. 4,5,9,17 The forensic pathologist should have a high index of suspicion in the above-mentioned cases, and AE testing should be done at autopsy.…”