| Venous gas embolism is a rare but serious complication of laparoscopic and endoscopic procedures. We describe the case of a 33-year-old woman with a strictured hepaticojejunostomy anastomosis who was treated with transabdominal endoscopic balloon dilation. During the procedure, she suffered a venous gas embolus with immediate cardiovascular collapse. After treatment with pressors, electrical cardioversion, and multiple aspirations of the right ventricle, the patient recovered fully. We reviewed all reported cases of venous gas embolism during endoscopy over the past 30 years and identified multiple risk factors. We suggest precautions to minimize future complications in patients at increased risk. ( info) |
2/518. The use of cardiopulmonary bypass with profound hypothermia and circulatory arrest during the surgical treatment of giant intracranial aneurysms. The surgical treatment of giant intracranial aneurysms can be aided by using cardiopulmonary bypass to provide hypotension under hypothermic conditions. Cardiopulmonary techniques need to be modified to deal with the problems that arise during this type of neurosurgery. ( info) |
3/518. air embolism during anaesthesia for arthography in a child. An infant aged 5 months, weighing 6 kg and suffering from congenital dislocation of the hip joint, was subjected to air arthrography of the right hip joint under general anaesthesia. air embolism occurred following injection of air into the joint. The clinical management is described. resuscitation was successfully accomplished and the patient was discharged from hospital without untoward sequelae. ( info) |
4/518. Bronchial-atrial fistula after lung transplant resulting in fatal air embolism. We describe a rare case of fatal air embolism in a patient in whom a left atrial-bronchial fistula developed 1 month after single lung transplant. The cause was a combination of mediastinal infection and bronchial necrosis. ( info) |
5/518. death due to air embolism during sexual intercourse in the puerperium. We describe the cases of two young women who died due to air embolism during sexual intercourse early in the puerperium. ( info) |
| PURPOSE: Gas embolism during hysteroscopy is rare but sometimes fatal. A fatal case of gas embolism during diagnostic hysteroscopy using carbon dioxide (CO2) is presented. CLINICAL FEATURES: A 68 yr old woman was admitted for treatment of myoma and cancer of the uterus. hysteroscopy using CO2 was performed without monitoring or anesthesia on the ward. At the end of the examination, just after the hysteroscope was removed, she developed tonic convulsions, lost consciousness, and her pulse was impalpable. Cardiac massage was started, anesthesiologists were called and the trachea was intubated. She was transferred to the intensive care unit with continuous cardiac massage. Cardiac resuscitation was successful. A central venous line was inserted into the right ventricle under echocardiography in an attempt to aspirate gas with the patient in the Trendelenberg position, but the aspiration failed. Positive end expiratory pressure and heparin for emboli, midazolam for brain protection, and catecholamines were administered. Fifteen hours after resuscitation, the pupils were enlarged and she died 25 hr after resuscitation. CONCLUSION: Gas embolism is a rare complication of hysteroscopy. The procedure should be performed with monitoring of blood pressure, heart rate, oxygen saturation and end-tidal CO2 concentration. ( info) |
7/518. Neurological deficit following spinal anaesthesia: MRI and CT evidence of spinal cord gas embolism. A 62-year-old diabetic woman developed permanent neurological deficits in the legs following spinal anaesthesia. MRI showed oedema in the spinal cord and a small intramedullary focus of signal void at the T10 level, with negative density at CT. Intramedullary gas bubbles have not been reported previously among the possible neurological complications of spinal anaesthesia; a combined ischaemic/embolic mechanism is hypothesised. ( info) |
8/518. Hyperbaric chamber-related decompression illness in a patient with asymptomatic pulmonary sarcoidosis. An asymptomatic 46-yr-old male sustained an acute neurologic insult, appearing during the decompression phase of a 50-m dry hyperbaric chamber dive. The right hemisyndrome was most probably related to diving, since symptoms responded rapidly to the early commenced recompression therapy. Further diagnostics revealed a previously unknown pulmonary sarcoidosis with bilateral pulmonary opacities and pleural adhesions that might have predisposed to arterial gas embolism secondary to pulmonary barotrauma. This case may illustrate a potential risk of decompression illness even during dry chamber dives in patients suffering from asymptomatic pleuro-parenchymal pulmonary disease. The value of chest X-ray in the medical assessment of fitness to dive is therefore emphasized. ( info) |
9/518. Fatal carbon dioxide embolism as an unreported complication of retroperitoneoscopy. Retroperitoneoscopy has gained popularity because it offers a safe alternative to the more debilitating open approach and avoids postoperative ileus. However, this type of procedure carries certain disadvantages in terms of intraperitoneal effusions and hemodynamic changes. Major complications are exceptional. We describe the case of a 52-year-old man who died of carbon dioxide embolism during elective totally extraperitoneal (TEP) inguinal hernioplasty for symptomatic left indirect inguinal hernia. With the patient under general anesthesia, the retroperitoneal space was gained through a 1. 5-cm incision made below the umbilicus. During the dissection, the patient collapsed and could not be resuscitated. At autopsy, air bubbles were admixed with blood in the epicardial veins, but no injury to vessels was demonstrated. We conclude that carbon dioxide embolism usually is caused by direct puncture of major vessels during intra-abdominal procedures. However, when this complication occurs during retroperitoneoscopy, it seems related to pressure-forced entry of carbon dioxide into the venous plexus. ( info) |
| We describe a case of paradoxical air embolism during orthotopic liver transplantation, early diagnosis, using intra-operative transoesophageal echocardiography after a circulatory failure, allowed early management by hyperbaric oxygen therapy. ( info) |