Gas Embolism

Coulter, Terrence D.; Wiedemann, Herbert; Eckmann, David M.; Branger, Annette B.; Cavanagh, Daniel; Chamorro, C.; Romera, M.; Pardo, C.; Muth, Claus M.; Shank, Erik S.

doi:10.1056/nejm200006293422617

Cited by 13 publications

(4 citation statements)

References 13 publications

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“…11,12 In other work, we studied sticking and sliding of a small ͑compared to vessel diameter͒ bubble along a microvessel wall using the boundary element method ͑BEM͒. [15][16][17] Transport of microbubbles is also relevant to air embolism [18][19][20][21] where bubble entrapment is undesirable. 3 In our microchannel experiments we observed that bubbles usually contacted the wall, especially at low pressures, and we investigated a hysteresis region in which the bubble did not split evenly even with no effect of gravity.…”

Section: Introductionmentioning

confidence: 99%

A boundary element model of the transport of a semi-infinite bubble through a microvessel bifurcation

et al. 2010

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Motivated by a developmental gas embolotherapy technique for selective occlusion of blood flow to tumors, we examined the transport of a pressure-driven semi-infinite bubble through a liquid-filled bifurcating channel. Homogeneity of bubble splitting as the bubble passes through a vessel bifurcation affects the degree to which the vascular network near the tumor can be uniformly occluded. The homogeneity of bubble splitting was found to increase with bubble driving pressure and to decrease with increased bifurcation angle. Viscous losses at the bifurcation were observed to affect the bubble speed significantly. The potential for oscillating bubble interfaces to induce flow recirculation and impart high stresses on the vessel endothelium was also observed.

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Section: Introductionmentioning

confidence: 99%

A boundary element model of the transport of a semi-infinite bubble through a microvessel bifurcation

et al. 2010

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“…As was described above, the organ involved in air embolism is a critical factor for patients' symptoms and outcomes, and it is therefore natural for location of the air embolism in the coronary arteries and intracranial spaces to be a significant predictor of unfavorable outcomes. There has been controversy about application of the Trendelenburg position for patients with air embolism [61,90,111,[113][114][115]. According to some authorities, the Trendelenburg position is only appropriate for cases of venous air embolism, as it keeps the air bolus in the right ventricular cavity [114,115].…”

Section: Discussionmentioning

confidence: 99%

“…There has been controversy about application of the Trendelenburg position for patients with air embolism [61,90,111,[113][114][115]. According to some authorities, the Trendelenburg position is only appropriate for cases of venous air embolism, as it keeps the air bolus in the right ventricular cavity [114,115]. Nevertheless, our systematic review revealed that patients who had been placed in the Trendelenburg position for air embolism tended to have favorable outcomes (20 of 25 patients, p = 0.084 in the univariate analysis) and most of these patients had arterial air embolism (23 of 25 patients).…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis

et al. 2020

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Objectives To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis. Methods We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed. Results The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048–0.128%; I2 = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029–34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103–91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725–14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149–9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309–20.447; p = 0.019). Conclusion The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB. Key Points • The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.

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“…In such cases, CO 2 insufflation should be terminated and 100% oxygen should be provided. Patients were placed in the left lateral decubitus and Trendelenburg position to preclude the gas emboli from occluding the right ventricular outflow tract [ 62 ].…”

Section: Operative Techniquesmentioning

confidence: 99%

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

Liang

Chen

Liu

2022

Cancers

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Transoral thyroidectomy is a novel technique that uses three small incisions hidden in the oral vestibule to remove the thyroid gland. It provides excellent cosmetic results and outcomes comparable to the open approach. One of the main obstacles for this technique is the creation of a working space from the lip and chin to the neck. The anatomy of the perioral region and the top-down surgical view are both unfamiliar to general surgeons. As a result, inadequate manipulation might easily occur and would lead to several unconventional complications, such as mental nerve injury, carbon dioxide embolism, and skin perforation, which are rarely observed in open surgery. Herein, we summarize the basic concepts, techniques, and rationales behind working space creation in transoral thyroidectomy to assist surgeons in obtaining an adequate surgical field while eliminating preventable complications.

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Gas Embolism

Cited by 13 publications

References 13 publications

A boundary element model of the transport of a semi-infinite bubble through a microvessel bifurcation

A boundary element model of the transport of a semi-infinite bubble through a microvessel bifurcation

Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

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