Equipment modification to prevent air embolism with LEVEL 1® H-500 fluid warmer

I describe the pathophysiological and hemodynamic events that occur after an emergency pneumonectomy for trauma and how they impact on subsequent mortality. Four patients were identified as requiring an emergency right pneumonectomy for trauma at a level 1 Urban Trauma Center within a 39-month period. A retrospective review of their hospital course served as the basis for our analysis. Three patients sustained gunshot wounds and one patient was a victim of blunt trauma. Hemodynamic data were available for three patients who survived more than 24 hours. All patients presented in shock and required massive transfusion. One patient died in the operating room due to air embolism and shock. After pneumonectomy, there was an increase in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) more than 2 times normal, which coincided with a decrease in stroke volume, cardiac output, and right and left ventricular stroke work (RVSW/LVSW). The RVSW gradually increased to above normal levels by postoperative day 5, whereas the LVSWI remained below normal. Adult respiratory distress syndrome (ARDS) developed in all patients early in the postoperative period. There was evidence of oxygen delivery (DO2) dependent of oxygen consumption (VO2) and the DO2 remained below normal despite inotrope administration. The remaining three patients died 7 to 13 days after surgery due to various combinations of ARDS, cardiac failure, and sepsis. Until we have better methods to decrease PAP selectively, traumatic pneumonectomy should be avoided if possible, especially when it involves the right side or is associated with a contralateral lung injury. Early operative intervention and control of the pulmonary hilum may lessen the severity of shock. The hemodynamic changes that occur after pneumonectomy for trauma becomes additive in the presence of ARDS. This combination results in inadequate cardiac function, oxygen transport, and, ultimately, death.

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Durasi Operasi yang Memanjang pada Pasien dengan Tumor Cerebellopontine Angle (CPA)

Jurnal Neuroanestesi Indonesia ◽

10.24244/jni.v9i1.242 ◽

2020 ◽

Vol 9 (1) ◽

pp. 45-50

Author(s):

Harrison Harrison ◽

Kenanga M. Sikumbang ◽

Rapto Hardian

Keyword(s):

Ct Scan ◽

Cerebellopontine Angle ◽

Anesthetic Management ◽

Air Embolism ◽

Volume Replacement ◽

Fluid Replacement ◽

Neurophysiological Monitoring ◽

Fluid Warmer ◽

Venous Air Embolism ◽

Duration Of Surgery

Tumor Cerebellopontine angle (CPA) merupakan tumor fossa posterior terbanyak dan merupakan 5-10% dari tumor intrakranial. Penatalaksanaan anestesi pada kasus tumor CPA sangat menantang, dan memerlukan perhatian khusus terhadap disfungsi batang otak, posisi pasien, pemantauan neurofisiologi intraoperatif, dan adanya risiko venous air embolism (VAE). Pasien wanita, 16 tahun, 45 kg, suspek CPA tipe schwannoma akustik dengan keluhan sakit kepala selama 2 bulan. Tidak ada riwayat tinitus dan gangguan keseimbangan. CT-scan kepala memperlihatkan massa padat dengan bagian kistik di cerebellopontine angle kanan. Prosedur pembedahan dilakukan dalam posisi prone dan memanjang hingga 13 jam. Rumatan anestesi ditujukan untuk stabilisasi hemodinamik dan pencegahan hipotermia dengan penghangat blower dan infus hangat. Perdarahan selama pembedahan sekitar 1800 ml. Pasien diekstubasi setelah 3 hari di ICU. Prosedur bedah untuk tumor CPA memiliki risiko tinggi dan membutuhkan waktu lama, sehingga meningkatkan mortalitas dan morbiditas akibat risiko hipotermia dan ketidakstabilan hemodinamik yang lebih tinggi. Pada kasus ini dengan keterbatasan alat monitoring, dilakukan observasi ketat untuk kejadian VAE dan pencegahan komplikasi pascabedah dengan menjaga hemodinamik tetap stabil dengan pemberian cairan adekuat dan pencegahan hipotermia dengan penggunaan blower warmer dan infus hangat. Pada kasus ini, lama pembedahan selama 13 jam diantisipasi dengan monitoring yang ketat, pemberian volume adekuat dan pencegahan hipotermi. Prolonged Operation in Patient with Cerebellopontine Angle (CPA) TumorAbstractCerebellopontine angle (CPA) tumor is the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Anesthetic management is very challenging and needs special attention due to brain dysfunction, patient position, neurophysiological monitoring intraoperative, and the risk of venous air embolism (VAE). Female patient, 16 years old, 45 kg, with a suspected CPA acoustic schwannoma presented headache for 2 months. No history of tinnitus and balance disorders. Head CT-scan showed solid mass with cystic sections at right cerebellopontine angle. During procedure patient was in prone position and the operation took 13 hours long. Maintenance anesthesia aims to stabilize hemodynamic with adequate fluid replacement and prevention hypothermia with blower warmer and fluid warmer. Blood loss during the operation about 1800 ml. The patient was extubated after 3 days in the ICU. Surgical procedure in cerebellopontine angle surgery has a high risk and requires a long time. Prolonged duration of surgery will increases mortality and morbidity, because of the higher risk of hypothermia and hemodynamic instability. With limited monitoring equipment, we stabilize hemodynamic and to prevent the risk of VAE by adequate volume replacement. Hypothermia prevention by blower and fluid warmer. In this case, 13 hours long the operation makes us should maintenance hemodynamic by given adequate volume replacement and prevention of hypothermia.

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Aluminium leaching in fluid warming devices – A Review

10.21203/rs.3.rs-1261429/v1 ◽

2022 ◽

Author(s):

Danielle K. Bayoro ◽

Daniel Hoolihan ◽

Michael J Pedro ◽

Edward A. Rose ◽

Andreas D. Waldmann

Keyword(s):

The Body ◽

Intravenous Fluids ◽

Fluid Warmer ◽

Ensure Patient Safety ◽

Level 1 ◽

Instructions For Use ◽

Clinical Conditions ◽

Warming Devices ◽

Current Guidelines ◽

Aluminium Leaching

Abstract Current guidelines recommend the use of an intravenous fluid warmer to prevent perioperative hypothermia. Among the various methods of warming intravenous fluids, contact warmers are among the most effective and accurate, particularly in clinical conditions requiring rapid infusions of refrigerated blood or fluids. Contact warmers put the infusate in direct contact with a heating block. Some fluid warmers use heating blocks manufactured from aluminium. Several recent publications, however, have shown that uncoated aluminium blocks can leach potentially toxic amounts of aluminium into the body. In this review we performed a systematic literature review on aluminium leaching with contact fluid warmers and describe what manufacturer and competent authorities did in the past years to ensure patient safety. The search resulted in five articles describing the aluminium leaching. Four different devices (Level 1 Fluid Warmer from Smiths Medical, ThermaCor from Smisson-Cartledge Biomedical, Recirculator 8.0 from Eight Medical International BV, enFlow from Vyaire) were shown to leach high levels of aluminium when heating certain intravenous fluids. One manufacturer (Vyaire) voluntarily removed their product from the market, while three manufacturers (Eight Medical International BV, Smisson-Cartledge Biomedical, and Smiths Medical) revised the instructions for use for the affected devices. The enFlow fluid warmer was subsequently redesigned with a parylene coating over the heating block. The scientific literature shows that by using a thin parylene layer on the heating block, the leaching of aluminium can be nearly eliminated without affecting the heating performance of the device.

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Quantification of safe aluminium levels released into infusion solutions by the Level 1 Fast Flow Fluid Warmer: a reply

Anaesthesia ◽

10.1111/anae.15174 ◽

2020 ◽

Vol 75 (9) ◽

pp. 1253-1254

Author(s):

J. A. Cabrera ◽

L. K. Borton

Keyword(s):

Fluid Warmer ◽

Level 1 ◽

Fast Flow

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