Arterial air embolism of venous origin in dogs: effect of nitrous oxide in combination with halothane and pentobarbitone

Butler, Bruce D; Leiman, Basil C.; Katz, Jeffrey A.

doi:10.1007/bf03010513

Cited by 11 publications

(5 citation statements)

References 29 publications

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“…85 In several animal models, a close relationship between VAE and PAE has been described. 29 114 119 However, not every VAE results in PAE, and the clinical consequences depend on the quantity of air that crosses over into the arterial circulation. 33 Accordingly, great attention should be paid to minimizing the frequency and volume of air in any position during surgery, as VAE also occurs in the horizontal position and in other types of surgery regardless of the presence of PFO.…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale and neurosurgery in sitting position: a systematic review

Fathi

Eshtehardi

Meier

2009

British Journal of Anaesthesia

135

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We have conducted a systematic review of air embolism complications of neurosurgery in the sitting position and patent foramen ovale (PFO) closure. It assesses the risk and benefit of PFO closure before neurosurgery in the sitting position. The databases Medline, Embase, and Cochrane Controlled Trial Register were systematically searched from inception to November 2007 for keywords in both topics separately. In total, 4806 patients were considered for neurosurgery in sitting position and 5416 patients underwent percutaneous PFO closure. The overall rate of venous air embolism during neurosurgery in sitting position was 39% for posterior fossa surgery and 12% for cervical surgery. The rate of clinical and transoesophageal echocardiography detected paradoxical air embolism was reported between 0% and 14%. The overall success rate for PFO closure using new and the most common closure devices was reported 99%, whereas the average risk of major complications is <1%. On the basis of our systematic review, we recommend screening for PFO and considering closure in cases in which the sitting position is the preferred neurosurgical approach. Our proposed management including the time of PFO closure according to available data is presented. However, the conclusions from our systematic review may be limited due to the lack of level A evidence and from using data from observational cohort studies. Thus, definite evidence-based recommendations require prospective evaluation of the issue in well-designed studies.

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Section: Discussionmentioning

confidence: 99%

Patent foramen ovale and neurosurgery in sitting position: a systematic review

Fathi

Eshtehardi

Meier

2009

British Journal of Anaesthesia

135

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“…PULMONARY GAS EMBOLI DISTRIBUTION not many studies address the changes in size of bubbles, and those that do have studied the effects of different gas types on the size of the bubbles (8,37,39,41). A recent modeling study (42) of stabilized bubbles in the circulation indicates that bubbles reach maximal size in the pulmonary small vessel beds because blood pressure is low, there is no inherent unsaturation, and gases from the alveoli diffuse into the bubble.…”

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confidence: 99%

Spatial distribution of venous gas emboli in the lungs

Souders¹,

Doshier²,

Polissar³

et al. 1999

Journal of Applied Physiology

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The distribution of gaseous pulmonary emboli is presumed to be determined by their buoyancy. We hypothesized that regional pulmonary blood flow may also influence their distribution. Therefore, pulmonary blood flow was measured in supine, anesthetized dogs with use of 15-microm fluorescent microspheres at baseline and during N(2) embolism. The animals were killed, and the lungs were excised, air-dried, and diced into approximately 2-cm(3) pieces with weights and spatial coordinates recorded. Embolism was defined as a >10% flow decrease relative to baseline. Vertically, the incidence of embolism increased substantially by 6 +/- 1% per additional centimeter in height compared with baseline (P = 0.0003). Embolism also increased radially by 3 +/- 1%/cm from the hilum (P = 0.002). There was a weaker but statistically significant increase in embolism to pieces with greater baseline flow, 9 +/- 2% for every 1. 0 increase in relative baseline flow (P = 0.008). We conclude that the distribution of gaseous emboli is influenced by buoyancy and flow dynamics within the pulmonary vasculature.

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“…[23] A critical incident study of perioperative events in 1987 found that the pulse oximeter warned of a life-threatening problem in 5% of all anaesthetics. [24] We found that the highest percentage of active intervention by the anaesthetist was required for operations involving regional anaesthesia (46%) than for general anaesthesia (43%). For patients undergoing caesarean sections by RA, 51% required intervention by the anaesthetist.…”

Section: Discussionmentioning

confidence: 97%

The impact of increasing oximetry usage in India: A pilot study

et al. 2011

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The overall goal of the global oximetry (GO) project was to increase patient safety during anaesthesia and surgery in low and middle income countries by decreasing oximetry costs and increasing oximetry utilisation. Results from the overall project have been previously published. This paper reports specifically on pilot work undertaken in four hospitals in one Indian State. The aim of this work was to assess the impact of increasing oximetry provision in terms of benefits to anaesthetists and in the identification of patient problems during anaesthesia, to identify training needs and to explore perceptions regarding barriers to more comprehensive oximetry coverage. Data collection was by interview with hospital staff, use of a log-book to capture data on desaturation episodes and a follow-up questionnaire at 10 months after the introduction of additional oximeters. Increasing oximetry utilisation in the four hospitals was viewed positively by the anaesthetic staff and enabled improvement in monitoring patients. Of the 939 monitored patients studied, 214 patients (23%) experienced a total of 397 desaturation episodes. For nearly half of the patients undergoing caesarean section under regional anaesthesia following a desaturation event supplementary oxygen was required. In 53 of the 379 female sterilisations (14%) desaturation episodes occurred and in eight patients, there were 17 episodes of desaturation due to obstruction. In the recovery room, 91 of the 939 patients were monitored using the oximeters with 12 patients (13%) requiring oxygen. This study has highlighted that pulse oximetry must be used even in patients having surgical procedures or caesarean section under regional or local anaesthesia as these procedures are associated with hypoxic episodes. Anaesthetists must ensure they are complying with the Indian Society of Anaesthesiologists monitoring standards for anaesthesia and ensure patients are monitored by pulse oximetry.

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Arterial air embolism of venous origin in dogs: effect of nitrous oxide in combination with halothane and pentobarbitone

Cited by 11 publications

References 29 publications

Patent foramen ovale and neurosurgery in sitting position: a systematic review

Patent foramen ovale and neurosurgery in sitting position: a systematic review

Spatial distribution of venous gas emboli in the lungs

The impact of increasing oximetry usage in India: A pilot study

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