Iatrogenic cerebral arterial gas embolism from flushing of the arterial line in two calves

Abstract

BackgroundMeasurement of invasive blood pressure as reflection of blood flow and tissue perfusion is often carried out in animals during general anesthesia. Intravascular cannulation offers the potential for gas to directly enter the circulation and lead to arterial gas embolism. Cerebral arterial gas embolism may cause a spectrum of adverse effects ranging from very mild symptoms to severe neurological injury and death. Although several experimental models of arterial gas embolism have been published, there are no known published reports of accidental iatrogenic cerebral arterial gas embolism from flushing of an arterial line in animals.Case presentationA 7-day-old Red Holstein–Friesian calf (No. 1) and a 28-day-old Holstein–Friesian calf (No. 2) underwent hot iron disbudding and sham disbudding, respectively, under sedation and cornual nerve anesthesia. Invasive arterial blood pressure was measured throughout the procedure and at regular intervals during the day. Before disbudding, a sudden and severe increase of blood pressure was observed following flushing of the arterial line. Excitation, hyperextension of the limbs and rapid severe horizontal nystagmus appeared shortly thereafter. Over the following minutes, symptoms ameliorated and blood pressure normalized in both cases. Prompt diagnosis was missed in calf 1; supportive fluid therapy was provided. Severe deterioration of neurologic status occurred in the following 24 h and culminated with stupor. The calf was euthanized for ethical reasons and the histological examination revealed extensive cerebral injury. Treatment of calf 2 consisted of supportive fluid and oxygen therapy; furosemide (1 mg/kg IV) was injected twice. Calf 2 appeared clinically normal after 2 h and showed no neurologic sequelae on a 3-month-follow up period.ConclusionsThere are no known reports of cerebral arterial gas embolism following flushing of the auricular arterial line in calves. The injection of a small amount of air at high pressure in a peripheral artery may lead to a significant cerebral insult. The clinical presentation is non-specific and can favour misdiagnosis and delay of therapy.

Cerebral Air Embolism After Gastrointestinal Procedure: A Case Report and Literature Review

“…Different gases can lead to this condition including air, which is the most common cause, carbon dioxide, nitrous oxide, nitrogen and others [ 8 ]. Most of the times, this situation is iatrogenic and can occur during procedures such as EGD, colonoscopy, enteroscopy, sigmoidoscopy, endoscopic ultrasound, ERCP, surgical procedures, intravenous catheterization, hemodialysis, interventional radiological procedures, positive pressure ventilation and trauma [ 9 ]. In this literature review, we will focus on cerebral gas embolism after different gastroenterology procedures.…”

Catheter‐associated air embolism of the brain in a hospitalised horse

“…1,2 Venous air embolism (VAE) is an uncommon, potentially life-threatening complication in horses that has been reported in other species, including dogs, cats, cattle and humans. [3][4][5][6] VAE in horses can be the result of accidental disconnection of the extension set or injection cap from the catheter or from damage to the extension set, fluid line or three-way stopcock. 1,7,8…”