Gas embolism complicating obstetric or gynecologic procedures. Case reports and review of the literature

Mushkat, Yaron; Luxman, Dov; Nachum, Zohar; David, Menachem P.; Melamed, Yuval

doi:10.1016/0301-2115(95)02221-r

Cited by 31 publications

(8 citation statements)

References 32 publications

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“…Preconditions for venous AE include a hydrostatic gradient favouring the intravascular entry of air and incising of noncollapsed veins: the epiploic and emissary veins, veins of the throat and dural venous sinuses in patients undergoing craniotomy in the sitting position [246]. It may enter the veins of the myometrium [247] during surgical or diagnostic gynaecological procedures [248]. The incidence of AE during surgery, as assessed by precordial Doppler, ranges from 7-69% [249].…”

Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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“…Bricker and colleagues used transoesophageal echocardiography in patients who required mechanical ventilation with positive end‐expiratory pressure (PEEP) and found continuous venous air embolism in five of the eight lung trauma patients (Bricker et al ., 1994); they concluded that there is a relatively high occurrence of venous air embolism in patients with pulmonary barotrauma associated with increased ventilatory pressures, and that venous emboli may contribute to cardiovascular instability and may exacerbate lung injury in critically ill patients. In gynaecological surgical and diagnostic procedures, venous air embolism is a rare and unexpected complication (Mushkat et al ., 1995; Weissman et al ., 1996). Laparoscopy using carbon dioxide can also lead to a venous CO 2 embolism (McGrath et al ., 1989).…”

Section: Clinical Occurrencementioning

confidence: 99%

Gas embolism: pathophysiology and treatment

Hulst

Klein

Lachmann

2003

Clin Physio Funct Imaging

193

194

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Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and then addresses venous air embolism by discussing pulmonary vascular filtration, entrapment, and the clinical occurrence of venous air emboli. The section on arterial gas embolism deals with the main mechanisms involved, coronary and cerebral air embolism (CAE), and the effects of bubbles on the blood-brain barrier. The diagnosis of CAE uses various techniques including ultrasound, perioperative monitoring, computed tomography, brain magnetic resonance imaging and other modalities. The section on therapy starts by addressing the primary treatment goals and the roles of adequate oxygenation and ventilation. Then the rationale for hyperbaric oxygen as a therapy for CAE based on its physiological mode of action is discussed, as well as some aspects of adjuvant drug therapy. A few animal studies are presented, which emphasize the importance of the timing of therapy, and the outcome of patients with air embolism (including clinical patients, divers and submariners) is described.

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“…In humans, the condition is encountered with manipulation, exchange, or accidental disconnection of central venous catheters . Vascular air embolism also can result from surgery, particularly obstetric procedures and procedures of the cranium performed in the sitting position, because of the favorable pressure gradients produced …”

Section: Introductionmentioning

confidence: 99%

Catheter‐associated venous air embolism in hospitalized horses: 32 cases

Parkinson

McKenzie

Barton

et al. 2018

Veterinary Internal Medicne

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BackgroundVenous air embolism is a potentially life‐threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have been reported in the literature and the prognosis is currently unknown.Hypothesis/ObjectivesOur objective was to describe the surrounding circumstances, clinical signs, treatment, progression, and outcome of venous air embolism in hospitalized horses.AnimalsThirty‐two horses with acute onset of compatible clinical signs associated with IV catheter disconnection or damage.MethodsMulticenter retrospective study. Data extracted from clinical records included signalment, presenting complaint, catheter details, clinical signs, treatments, and outcome.ResultsMost cases resulted from extension set disconnection occurring within approximately 24 hours after catheter placement. In fewer horses, extension set damage was cited as a cause. Common clinical signs included tachycardia, tachypnea, recumbency, muscle fasciculations and agitation, with abnormal behavior including kicking and flank biting. Less commonly, pathological arrhythmias or more severe neurologic signs, including blindness and seizures, were noted. Progression was unpredictable, with some affected horses developing delayed‐onset neurologic signs. Mortality was 6/32 (19%), including 2 cases of sudden death and other horses euthanized because of persistent neurologic deficits. Negative outcomes were more common in horses with recorded blindness, sweating or recumbency, but blindness resolved in 5/8 affected horses.Conclusions and Clinical ImportanceThe prognosis for resolution of clinical signs after air embolism is fair, but permanent neurologic deficits or pathologic cardiac arrhythmias can arise. Unpredictable progression warrants close monitoring. Systematic clinic‐based surveillance could provide additional useful information to aid prevention.

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Gas embolism complicating obstetric or gynecologic procedures. Case reports and review of the literature

Cited by 31 publications

References 32 publications

Nonthrombotic pulmonary embolism

Nonthrombotic pulmonary embolism

Gas embolism: pathophysiology and treatment

Catheter‐associated venous air embolism in hospitalized horses: 32 cases

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