Venous Air Embolism During Cesarean Section: More Common Than Previously Thought

Lew, Thomas; Tay, D. H. B.; Thomas, E.

doi:10.1097/00006254-199403000-00009

Cited by 12 publications

(17 citation statements)

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“…Various incidences from 11% to 65% have been reported elsewhere [2,3], and a high incidence of 97% has been observed by monitoring the expired nitrogen concentration [4]. Generally, VAE is slight and its effects on respiration and circulation are limited.…”

Section: Discussionmentioning

confidence: 99%

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A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

et al. 1995

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Section: Discussionmentioning

confidence: 99%

“…A high incidence of venous air embolism (VAE) has been reported during cesarean section, but serious cases of this complication are comparatively few [1][2][3][4]. In the present report, we describe a case of pulmonary arteriovenous fistula complicated by possible postoperative subendocardial infarction due to VAE during cesarean section.…”

Section: Introductionmentioning

confidence: 93%

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

et al. 1995

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“…Echocardiography may become more important in the diagnosis of VAE outside the operating room as expertise and equipment availability increase in the critical care environment. Pressure infusion devices [53][54][55] Shoulder arthroscopy 16,17 Mechanical ventilation 3,4,37 Surgery on the spine 18,19 Cavitron ultrasonic surgical aspirator® for hepatic resection 38,39 Total hip arthroplasty 20 Argon beam coagulator [40][41][42] Cesarean delivery 21 YAG laser 34 Prostate surgery 22,23 Endoscopic vein harvesting [43][44][45] Liver surgery 24 -26 Endoscopy 46 -48 Eye surgery 27 Use of hydrogen peroxide [49][50][51][52] 58 These pressures can easily exceed venous pressure depending on the patient's volume status and position. Because insufflation during gastrointestinal endoscopy is intermittent and low pressure, the risk of VAE is low.…”

Section: Surgery Above the Heartmentioning

confidence: 99%

“…The neodymium:yttrium-aluminum-garnet (YAG) laser requires the use of high flow air, CO 2 , or N 2 as a coolant because of the high temperatures generated by the instrument tip. 21 The Cavitron Ultrasonic Surgical Aspirator® uses ultrasonic mechanical energy to vaporize fluid within cells, causing the cells to fragment and release vapor. 59 The use of hydrogen peroxide is another example of generated gas capable of causing embolism.…”

Section: Surgery Above the Heartmentioning

confidence: 99%

Venous Air Embolism

Borromeo

2010

Surgical Intensive Care Medicine

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DefinitionsGas embolism refers to the abnormal presence of gas within the circulatory system. It is a known complication of various surgical, therapeutic, and diagnostic procedures. It can also occur as a result of trauma. Gas embolism may be asymptomatic or may even result in immediate cardiovascular collapse. The type and severity of sequelae depend on the composition and amount of gas, the rate and location of entry, and on patient characteristics such as size, cardiopulmonary reserve, and presence of an intracardiac rightleft communication. An understanding of the etiologies and pathophysiology of gas embolism is important in order to recognize, treat, and, most importantly, prevent this potentially catastrophic complication.Gas enters the circulation when two conditions co-exist: (1) a communication between a gas source and the vascular system, and (2) a pressure gradient that favors gas entry into the vasculature. When the atmosphere is the source of gas, then this condition is termed air embolism. Gas can be entrained into open veins or venous sinuses, insufflated into traumatized vessels, or accidentally infused under pressure through indwelling venous or arterial catheters. Rarely, dissolved gas is released in blood through effervescence caused by rapid re-warming or decompression. 1 Venous (pulmonary) gas embolism (VGE) refers to gas that gains entry into the venous system and causes morbidity via its effects on the right heart and pulmonary vasculature. Systemic (arterial) gas embolism (SGE) results from gas that is propelled by the left heart and embolizes to systemic arterial beds causing ischemia and infarction. Paradoxical gas embolism (PGE) originates in the venous system and gains access to the arterial system through intracardiac defects or the pulmonary circulation.

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“…A bubble forming in the circulatory system can lead to pulmonary or cerebral gas emboli. Formation and/or introduction of gas microbubbles in human blood and tissues remains a serious long-term sequel in patients undergoing cardiac valve replacement (with an annual risk of up to 4%) [2][3][4]; cardiopulmonary bypass and other open-heart surgeries [3-8]; high-intensity focused US therapy [9][10][11]; cesarean section and operative hysteroscopy [12][13][14][15][16][17][18][19][20][21][22][23][24]; orthopedic surgery [25,26]; and various laser ablation and laparoscopic surgeries [27][28][29][30]. Additionally, gas embolism happens in endoscopy [31], tissue biopsy [32], neurosurgery [33], liver transplantation [34][35][36], during central venous line insertion and removal [37,38], and even during intravenous antibiotic delivery at home [39].…”

Section: Introductionmentioning

confidence: 99%

Novel Method of Noninvasive Detection and Assessment of Gas Emboli and DCS

Larin¹

2010

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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information SSOCT has been developed. The system has an axial resolution of 10 µm, phase sensitivity of 0.03 radians, imaging depth of up to 6 mm in air, and in-depth scanning speed of 20 kHz for a single A-line. The performance of the sensing system was carefully evaluated in optical phantoms containing gas microbubbles with different diameter and tissues in vivo. Obtained results demonstrate that bubbles with diameter greater than 10 µm could be detected by both structural imaging and phase response whereas bubbles with diameters less than 10 µm could be detected by the phase response of the SSOCT with high sensitivity.Noninvasive, optical, microbbules, decompression AbstractNoninvasive functional imaging, monitoring and quantification of microbubbles forming in blood and tissues upon rapid changes in barometric pressure are extremely important for effective therapy and diagnostics of several diseases as well as for imaging and drug delivery projects. However, current techniques are unable of imaging and efficient detection of bubbles with diameter less than 50 micrometers. The goal of this proposal was to develop novel PhaseSensitive Swept Source Optical Coherence Tomography (PhS-SSOCT) technique capable of real-time, sensitive, accurate, and noninvasive imaging, monitoring, and quantification of microbubbles in tissues. During these studies, a novel phase resolved system based on Swept Source Optical Coherence Tomography (SSOCT) has been developed. The system has an axial resolution of 10 µm, phase sensitivity of 0.03 radians, imaging depth of up to 6 mm in air, and in-depth scanning speed of 20 kHz for a single A-line. The performance of the sensing system was carefully evaluated in optical phantoms containing gas microbubbles with different diameter. Obtained results demonstrate that bubbles with diameter greater than 10 µm could be detected by both structural imaging and phase response whereas bubbles with diameters less than 10 µm could be detected by the phase response of the SSOCT with high sensitivity. The accuracy for measurement of the diameter of gas microbubbles is limited to 10 µm in structural imaging and 0.01 µm in phase-sensitive monitoring. Preliminary studies were also performed in animals in vivo for the rapid assessment of the circulating microbubbles. The in vivo results demonstrate capability of the developed instrument to image bubbles with diameter above 8 µm.The results from the study indicate that the developed SSOCT system could be used to detect fast-moving microbubbles and warr...

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Venous Air Embolism During Cesarean Section: More Common Than Previously Thought

Cited by 12 publications

References 0 publications

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

Venous Air Embolism

Novel Method of Noninvasive Detection and Assessment of Gas Emboli and DCS

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