Pulmonary (venous) air embolism

Body Position Does Not Affect the Hemodynamic Response to Venous Air Embolism in Dogs

“…The suggestion of therapeutic value of the LLR was originally based on the studies by Durant et al in the 1940s and 1950s (14,20). They found that dogs receiving venous infusions of 25 to 150 mL of air had higher survival rates when lying in the LLR position at the time of VAE compared with dogs lying in the RLR or in the SUP position.…”

“…Although the pathophysiology of VAE has been well documented (9,12,14,17,(20)(21)(22)(23), there has been little investigation into the hemodynamic benefits of body positioning for the treatment of VAE. This is important, because the efficacy of this therapy has been questioned (12,17).…”

“…In other words, if there were differences in the survival rates between different body positions, one would also expect differences in the hemodynamic responses. We therefore chose an air dose which was not associated with as high a mortality as previously evaluated (14,22). Since the average lethal dose of air in dogs has been found to be between 3.0 and 7.5 mL/kg (21,22,(24)(25)(26), we selected a dose of 2.5 mL/ kg.…”

“…Current therapy for VAE includes 100% oxygen ventilation and cessation of nitrous oxide (where applicable) to reduce bubble size as well as withdrawal of air from central veins, the right atrium, and pulmonary arteries (4,5,(10)(11)(12)(13). In cases of massive VAE that are not responsive to these measures alone, additional maneuvers, such as the left lateral recumbent (LLR) position, either horizontal or head down, external cardiac massage, and recompression therapy, with or without hyperbaric oxygen, may be necessary (4,5,(10)(11)(12)(14)(15)(16). The recommendation of the LLR position, known as "Durant's maneuver," is based primarily on animal studies performed by Durant et al (14) beginning in 1947.…”

Threshing grain of mechanism from chaffy myth of air embolism in laparoscopy - lux et veritas

“…In diastole, gas bubbles expand impeding blood flow by GL and TJ. 27 It causes diminished cardiac output, myocardial and cerebral ischemia, arrhythmias, hypercapnia, hypoxia, and hypotension with cardiovascular collapse. Some vasoactive factors and bronchospasm are also incriminated to compound mechanical obstruction in RH.…”