Paradoxical Air Embolism from a Patent Foramen Ovale

Gronert, Gerald A.; Messick, Joseph M.; Cucchiara, Roy F.; Michenfelder, John D.

doi:10.1097/00000542-197906000-00018

Cited by 140 publications

(28 citation statements)

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“…~'37 PEEP, IPPV and air embolism itself will increase the probability of an increase in fight venuicular and right atrial pressures. 37 In addition, moving from the supine to the erect position, causes the right atrium to move from a position above to a position below the left atrium. The pressure differential produced by this shift in position is low (2 mnaI-lg) but is certainly in the correct direction to connibute to this potential problem in individuals at risk.…”

Section: Paradoxical Air Embolismmentioning

confidence: 99%

Cardio-respiratory effects of change of body position

Coonan

Hope

1983

Can Anaesth Soc J

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Section: Paradoxical Air Embolismmentioning

confidence: 99%

Cardio-respiratory effects of change of body position

Coonan

Hope

1983

Can Anaesth Soc J

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“…However, in patients with persistent foramen ovale or an atrial or ventricular septa1 defect, as little as 0.5 ml of air is reported to cause serious damage to the heart and brain secondary to coronary and cerebral oxygen embolism [3]. In the absence of cardiac defects gas may still find its way from the pulmonary artery to the systemic circulation via pulmonary shunt vessels if the volume of gas is large or the entry sudden [4].…”

Section: Discussionmentioning

confidence: 99%

Hydrogen peroxide: an unusual cause of arterial and venous gas embolism

Neff¹,

Zulueta²,

Miller

1996

Anaesthesia

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SummaryA patient undergoing minor orthopaedic surgery suffered from unexpected arterial and venous gas embolism caused by hydrogen peroxide. We describe our management of the case and emphasise the need for continued vigilance during the use of hydrogen peroxide. Key wordsComplications; embolism, oxygen. Pharmacology; hydrogen peroxide.The use of hydrogen peroxide has been associated with a variety of potentially fatal complications such as surgical emphysema and oxygen embolism to various vascular beds of the body [I]. We report the unexpected occurrence of arterial and subsequent venous, oxygen embolism during a case of minor orthopaedic surgery in which the first sign of danger was the visualisation of gas in the vascular tree. Case historyA 22-year-old female patient (55 kg) presented for excision of an infected sinus in the left tibia. Six months previously a Denham pin had been inserted 2cm below the tibia1 tubercle to apply traction for an acetabular fracture following a road traffic accident. The pin was removed after 7 weeks and the patient discharged a few days later.The patient was fit, with no previous medical problems and an ASA 1 status. After oral premedication with metoclopramide 10 mg, ranitidine 150 mg and temazepam 10 mg anaesthesia was induced with midazolam 2 mg, fentanyl 50 pg and propofol 120 mg followed by insertion of a laryngeal mask airway. Arterial oxygen saturation (Spo,), inspiratory oxygen concentration (Ro2), end-tidal carbon dioxide concentration (Fk'co,), noninvasive blood pressure and electrocardiograph (mode V5) monitoring was started in the anaesthetic room and continued throughout the operation. Anaesthesia was maintained with isoflurane 0.7-1.2% in 60% nitrous oxide in oxygen, the patient breathing spontaneously from a Mapleson A breathing system. Morphine analgesia was administered in increments up to 5 mg in total. A tourniquet was applied (250 mmHg pressure) and the surgeon excised infected granulation tissue which was superficial as well as deep inside the former pin tract. The bony wound canal was irrigated with 10 ml of hydrogen peroxide 6% followed by 10 ml of 0.9% saline. After insertion of a Kaltostat wick the wound was closed and a dressing applied. Throughout the operation the patient remained normocapnoeic (Fk'co, 4.9-5.2 kPa), the systolic blood pressure between 95 and 110 mmHg and the pulse rate between 55 and 65 beat.min-I. After 26min operation time the tourniquet was deflated and the drapes removed.Within a few seconds of releasing the tourniquet the surgeon noted that the first and second toe of the foot were white, whereas the rest of the foot was pink. Gas bubbles were then noticed in the veins of the dorsum of the foot followed by a decrease in the end-tidal CO, concentration from 4.9 to 3.6 kPa. Auscultation of the heart revealed a classic 'mill-wheel' murmur. There was no evidence of haemodynamic instability shown by alterations in heart rate, rhythm or blood pressure.The tourniquet was immediately reapplied, the patient put in a left-lateral position...

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“…5 Venous air embolism always carries some risk of transfer of the air to the systemic circulation. 7 Pre-treatment of rabbits with PFE has been shown to provide protection from expert- water in the tissue can be evaluated by measuring relaxation times. 4 ' 5 We have already applied these techniques successfully to the problems of brain edema using cold injury, TET (triethyl-tin) intoxication, and brain tumor models in rats experimentally.…”

Section: Discussionmentioning

confidence: 99%

Protection from cerebral air emboli with perfluorocarbons in rabbits.

Spiess¹,

Braverman²,

Woronowicz³

et al. 1986

Stroke

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SUMMARY Cerebral air emboli have been implicated in the transient neurological deficits seen in patients after cardiovascular surgery. Since perfluorocarbon emulsions such as FC-43 have greater solubilities for gases compared to plasma, it was decided to investigate their potential in providing protection against transient ischemia produced by such emboli. Forty rabbits were divided into three groups of ten, twenty, and ten. They were anesthetized with acepromazine and kctamine and were given an infusion of either hetastarch or FC-43,10 ml/kg i.v. In Group I, which received a bolus air injection into the internal carotid artery, survival rates were: 2/5 for the hetastarch group and 5/5 for the FC-43 group (p < .05). In Group 2, which received an air infusion until the EEG was flat bilaterally, 3/10 hetastarch-treated rabbits survived while 10/10 FC-43-treated rabbits survived for 24 hours (p = .035). In Group 3, analysis of blood viscosity and osmolality over a four hour period following either hetastarch or FC-43 infusion resulted in no significant differences between the two treatments but a significant decrease in both variables after 30 minutes which returned to baseline values at 60 minutes. The results of the study demonstrate a protective effect from cerebral air emboli delivered into the internal carotid artery as either a bolus or slow infusion in rabbits pretreated with a perfluorocarbon emulsion in terms of survivability and recovery from transient neurological deficits. Stroke Vol 17, No 6, 1986 CEREBRAL AIR EMBOLISM (CAE) has been implicated in the transient neurological deficits that occur in up to 35% of the patients recovering from coronary artery bypass grafting.1 In addition, the incidence of venous air embolism in upright neurosurgical patients may be 20 to 40 percent with systemic embolism always a possibility.2 Any intervention that may reduce the size of the air emboli or protect the brain against an ischemic episode may prove beneficial in limiting the potentially devastating effects of CAE. The physical properties of perfluorocarbon emulsions (PFE) include increased solubilities of oxygen, nitrogen and carbon dioxide as compared to plasma and small particle sizes which provides them with a large surface area for gas exchange. These properties enable PFE to passively transport greater volumes of gases than plasma alone and suggest that PFE may provide protection against transient ischemia produced by CAE. Previous work in this laboratory has shown that PFE provided protection from venous air embolism in rabbits.3 The purpose of this study was to examine the effects of CAE on rabbits pretreated with PFE. MethodsForty New Zealand White rabbits, weighing 2 to 3 kg, were divided into groups often (Group 1), twenty (Group 2), and ten (Group 3). All experiments followed the guidelines for the care and use of laboratory animals published by the National Research Council.In Group 1 anesthesia was induced with a mixture of acepromazine 0.7 mg/kg, and ketamine 30 mg/kg, i.m. An endotracheal tube ...

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Paradoxical Air Embolism from a Patent Foramen Ovale

Cited by 140 publications

References 0 publications

Cardio-respiratory effects of change of body position

Cardio-respiratory effects of change of body position

Hydrogen peroxide: an unusual cause of arterial and venous gas embolism

Protection from cerebral air emboli with perfluorocarbons in rabbits.

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