Cerebral arterial gas embolism by helium: An unusual case successfully treated with hyperbaric oxygen and lidocaine

Mitchell, Simon J; Benson, Mark; Vadlamudi, Lata; Miller, Peter

doi:10.1016/s0196-0644(00)70086-2

Cited by 28 publications

(18 citation statements)

References 14 publications

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“…On the basis of the animal data presented above and case reports 37 suggesting a beneficial effect of lidocaine in the treatment of cerebral arterial gas embolism, Mitchell and colleagues 13 assessed the effect of lidocaine in 55 evaluable patients undergoing left heart valve surgery. Lidocaine was administered intravenously to 28 patients for a total duration of 48 hours.…”

Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blinded, Placebo Controlled Study of Neuroprotection With Lidocaine in Cardiac Surgery

Mathew

Mackensen

Phillips-Bute

et al. 2009

Stroke

139

128

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Background and Purpose Cognitive decline after cardiac surgery remains common and diminishes patients’ quality of life. Based on experimental and clinical evidence, this study assessed the potential of intravenously administered lidocaine to reduce postoperative cognitive dysfunction following cardiac surgery employing cardiopulmonary bypass. Methods Following IRB approval, 277 patients undergoing cardiac surgery were enrolled into this prospective, randomized, double-blinded placebo controlled clinical trial. Subjects were randomized to receive: 1) Lidocaine as a 1 mg/kg bolus followed by a continuous infusion through 48 hours postoperatively or 2) Placebo bolus and infusion. Cognitive function was assessed preoperatively and again at 6 weeks and 1 year postoperatively. The effect of lidocaine on postoperative cognition was tested using multivariable regression modeling; p <0.05 was considered significant. Results Among the 241 allocated subjects (Lidocaine: N=114; Placebo: N=127), the incidence of cognitive deficit in the lidocaine group was 45.5% versus 45.7% in the placebo group (p=0.97). Multivariable analysis revealed a significant interaction between treatment group and diabetes, such that diabetic subjects receiving lidocaine were more likely to suffer cognitive decline (p=0.004). Secondary analysis identified total lidocaine dose (mg/kg) as a significant predictor of cognitive decline and also revealed a protective effect of lower dose lidocaine in nondiabetic subjects. Conclusions Lidocaine administered during and after cardiac surgery does not reduce the high rate of postoperative cognitive dysfunction. Higher doses of lidocaine and diabetic status were independent predictors of cognitive decline. Protective effects of lower dose lidocaine in nondiabetic subjects need to be further evaluated.

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Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blinded, Placebo Controlled Study of Neuroprotection With Lidocaine in Cardiac Surgery

Mathew

Mackensen

Phillips-Bute

et al. 2009

Stroke

139

128

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“…Venous air embolism (VAE) is characterized by the entrapment of air (or exogenous gases, such as carbon dioxide, nitrous oxide, nitrogen, and helium) from broken venous vasculature in the central venous system 1-7. VAE can induce systemic effects, such as thromboembolism, to the right heart or pulmonary artery.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

Shin

Kwon

et al. 2013

Yonsei Med J

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PurposeVenous air embolism (VAE) is characterized by the entrainment of air or exogenous gases from broken venous vasculature into the central venous system. No study exists regarding the effect of patient positioning on the incidence of VAE during abdominal myomectomy. The purpose of this study was to assess the incidence and grade of VAE during abdominal myomectomy in the supine position in comparison to those in the head-up tilt position using transesophageal echocardiography.Materials and MethodsIn this study, 84 female patients of American Society of Anesthesiologist physical status I or II who were scheduled for myomectomy under general anesthesia were included. Patients were randomly divided into two groups: supine group and head-up tilt group. Transesophageal echocardiography images were videotaped throughout the surgery. The tapes were then reviewed for VAE grading.ResultsIn the supine group, 10% of the patients showed no VAE. Moreover, 10% of the patients were classified as grade I VAE, while 50% were categorized as grade II, 22.5% as grade III, and 7.5% as grade IV. In the head-up tilt group, no VAE was detected in 43.2% of the patients. In addition, 18.2% of the patients were classified as grade I VAE, 31.8% as grade II, and 6.8% as grade III; no patients showed grade IV. VAE grade in the head-up tilt group was significantly lower than that in the supine group (p<0.001).ConclusionThe incidence and grade of VAE in the head-up tilt group were significantly lower than those in the supine group during abdominal myomectomy.

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“…Σημαντικό, επίσης, ρόλο στην τελική έκβαση του α σθενούς διαδραματίζει η σύσταση του αέρα. Τις πε ρισσότερες φορές η εμβολή είναι από ατμοσφαιρικό αέρα, αλλά εμβολή μπορεί να επέλθει και από διο ξείδιο του άνθρακα, από μονοξείδιο του αζώτου, από άζωτο και από ήλιο (De la Torre et al 1962, McGrath et al 1989, Mitchell et al 2000. Οι εμβολές με ατμο σφαιρικό αέρα προκαλούν, λόγω της παρουσίας του αζώτου, καρδιακή αρρυθμία, καρδιακή ανεπάρκεια, πνευμονική υπέρταση και πνευμονικό οίδημα, ενώ η εμβολή με διοξείδιο του άνθρακα, εφόσον δεν είναι μαζική και ταχεία, έχει καλύτερη έκβαση δεδομένου ότι το διοξείδιο του άνθρακα είναι σαράντα φορές πιο ευδιάλυτο στο αίμα από τον ατμοσφαιρικό αέρα.…”

Section: περιγραφη περιστατικουunclassified

Fatal venous air embolism in swine during surgical procedure

Katsimpoulas

Kakisis

Peroulis

et al. 2018

J Hellenic Vet Med Soc

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Air embolism can occur after minor invasive procedures, as well as during major surgical operations. Reports of air embolism cases in veterinary literature are not very often, although it is considered that it happens more often than it is recognized. During a surgical procedure in swine, for the creation of a fistula of PTFE graft between the right common carotid artery and the right jugular vein under general anaesthesia, the animal died due to massive venous air embolism. Although it is supposed that the air was possibly inserted through the anaesthetic machine or through the anastomosis, the exact mechanism of the air insertion remains unknown.

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Cerebral arterial gas embolism by helium: An unusual case successfully treated with hyperbaric oxygen and lidocaine

Cited by 28 publications

References 14 publications

Randomized, Double-Blinded, Placebo Controlled Study of Neuroprotection With Lidocaine in Cardiac Surgery

Randomized, Double-Blinded, Placebo Controlled Study of Neuroprotection With Lidocaine in Cardiac Surgery

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

Fatal venous air embolism in swine during surgical procedure

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