scholarly journals Ocular Venous Air Embolism (OVAE): A Review

2019 ◽  
Vol 3 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Robert E. Morris ◽  
Gwendolyn L. Boyd ◽  
Mathew R. Sapp ◽  
Matthew H. Oltmanns ◽  
Ferenc Kuhn ◽  
...  
Keyword(s):  
Air Embolism ◽  
Choroidal Detachment ◽  
Effective Response ◽  
Effective Prevention ◽  
Venous Air Embolism ◽  
Pars Plana ◽  
Definition Of ◽  
End Tidal ◽  
Entrained Air ◽  
Effective Prevention Strategies

Purpose: The purpose of this article is to review and analyze reported cases of ocular venous air embolism (OVAE) to develop a reliable clinical definition of OVAE and effective prevention strategies. Methods: We reviewed all reports of suspected air embolism during vitrectomy published in PubMed since the introduction of pars plana vitrectomy, and 5 cases found elsewhere and separately reported concurrent with this review. Results: OVAE is a precipitous drop in end-tidal CO2, a choroidal detachment, or a choroidal wound, followed by signs of impending or actual cardiovascular collapse, during vitrectomy air infusion. In each case meeting the above clinical definition, entrained air was found whenever it was sought (8/8, 100%), either by antemortem imaging or postmortem forensic investigations. Most OVAE cases were fatal (9/13, 69%), with 8 of 9 deaths (89%) occurring the day of surgery. Conclusions: OVEA is a rare but usually fatal complication of air infusion into the eye during vitrectomy. Although received with skepticism when first reported (2005), OVAE may be the most lethal type of surgical air embolization because of its high entrainment pressure and proximity to the heart. Because the effective response time to avoid a fatal OVAE outcome can be less than 1 minute, use of preventive measures is critical—most notably a “time out” before air infusion to confirm infusion cannula positioning, and immediate cessation of air infusion if choroidal detachment is detected.

Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature

2017 ◽  
Vol 1 (5) ◽  
pp. 334-337 ◽  
Author(s):  
Sundeep K. Kasi ◽  
Scott Grant ◽  
Harry W. Flynn ◽  
Thomas A. Albini ◽  
Nidhi Relhan ◽  
...  
Keyword(s):  
Case Report ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Air Embolism ◽  
Choroidal Detachment ◽  
Fatal Complication ◽  
Ocular Surgery ◽  
Venous Air Embolism ◽  
Pars Plana ◽  
Air Exchange

Purpose: Presumed venous air embolism (PVAE) is a rare and potentially fatal complication of pars plana vitrectomy that is poorly described and understood but requires improved awareness among ophthalmologists and vitreoretinal surgeons. Methods: A case report is presented along with a systematic review of published reports of PVAE during ocular surgery. Results: An otherwise healthy adult male undergoing retinal detachment repair under local anesthesia with monitored anesthesia care died from a PVAE. Literature search yielded 2 experimental models, 6 individual case reports, and several editorials. Review of existing reports reveals that PVAE can affect patients of any age or gender with no medical predilection and occurs in cases of trauma, endoresection, or retinal detachment repair. It is typically associated with a drop in end-tidal carbon dioxide during fluid–air exchange and can present similar to a hemorrhagic choroidal detachment. Analysis suggests that venous air embolism can be prevented by ensuring full engagement of the infusion cannula into the vitreous cavity prior to fluid–air exchange. Conclusion: Presumed venous air embolism is a potentially fatal complication of ocular surgery and in some cases may be recognized by ophthalmologists as a choroidal detachment during fluid–air exchange in pars plana vitrectomy. It is imperative to immediately stop the air infusion line if venous air embolism is suspected.

scholarly journals Ocular Venous Air Embolism: A Report of 5 Cases

2019 ◽  
Vol 3 (2) ◽  
pp. 107-110 ◽  
Author(s):  
Robert E. Morris ◽  
Gwendolyn L. Boyd ◽  
Mathew R. Sapp ◽  
Matthew H. Oltmanns ◽  
Ferenc Kuhn ◽  
...  
Keyword(s):  
Rhegmatogenous Retinal Detachment ◽  
Preventive Measures ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Air Embolism ◽  
Surgical Wound ◽  
Fatal Complication ◽  
Effective Response ◽  
Venous Air Embolism ◽  
End Tidal

Purpose: The purpose of this case series is to report 5 new cases of ocular venous air embolism (OVAE). We define OVAE as a precipitous drop in end-tidal carbon dioxide, a choroidal detachment, or a choroidal wound, followed by signs of impending or actual cardiovascular collapse, during vitrectomy air infusion. Methods: A case report series was retrospectively reviewed. Results: Four of the 5 OVAE cases (80%) were fatal, occurring in conjunction with repair of rhegmatogenous retinal detachment (2 cases); a large surgical wound of the choroid (1 case); and vitrectomy repair of an injured eye (1 case). One patient survived OVAE during choroidal melanoma endoresection after prompt discontinuance of air infusion by anesthesia personnel previously alerted to the OVAE risk. Conclusions: OVAE is a rare but usually fatal complication of air infusion into the eye during vitrectomy. Because the effective response time to avoid a fatal OVAE outcome can be less than 1 minute, use of preventive measures is critical.

scholarly journals Hypoxaemia following Sustained Low-Volume Venous Air Embolism in Sheep

1988 ◽  
Vol 16 (2) ◽  
pp. 164-170 ◽  
Author(s):  
J. Pfitzner ◽  
S. P. Petito ◽  
A. G. McLean
Keyword(s):  
Arterial Oxygen Saturation ◽  
Air Embolism ◽  
Arterial Oxygen ◽  
Venous Air Embolism ◽  
Minute Period ◽  
Volume Ventilation ◽  
Gas Measurements ◽  
Respiratory Disturbance ◽  
Upright Head ◽  
End Tidal

In six upright (head above thorax) anaesthetised sheep, serial blood gas measurements were made over a 100-minute period during which repeated small-volume air emboli were injected intravenously to lower and maintain the end-tidal CO 2 concentration approximately 0.5% below its initial baseline level. With constant volume ventilation and an inspired N 2 O:O 2 ratio of 2:1, the arterial PCO 2 progressively increased and the arterial PO 2 progressively decreased with significant arterial hypoxaemia ensuing in three out of the six animals. It is suggested that during neurosurgery performed in the sitting position and with an inspired oxygen concentration of 33%, the degree of cardio-respiratory disturbance caused by venous air embolism should be assessed by continuous monitoring not only of end-tidal CO 2 concentration but also of arterial oxygen saturation using pulse oximetry.

Venous Air Embolism, Hypotension, and End-Tidal Nitrogen

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Jane M. Matjasko ◽  
Jeffrey Hellman ◽  
Colin F. Mackenzie
Keyword(s):  
Air Embolism ◽  
Venous Air Embolism ◽  
End Tidal

Venous Air Embolism during Endoscopic Strip Craniectomy for Repair of Craniosynostosis in Infants

2001 ◽  
Vol 95 (2) ◽  
pp. 340-342 ◽  
Author(s):  
Joseph D. Tobias ◽  
Joel O. Johnson ◽  
David F. Jimenez ◽  
Constance M. Barone ◽  
D. Scott McBride
Keyword(s):  
Surgical Procedures ◽  
Operating Time ◽  
Air Embolism ◽  
Postoperative Recovery ◽  
Surgical Time ◽  
Venous Air Embolism ◽  
Low Incidence ◽  
End Tidal ◽  
Neonates And Infants ◽  
Strip Craniectomy

Background Various studies have reported an incidence of venous air embolism (VAE) as high as 82.6% during surgical procedures for craniosynostosis. There has been an increase in the use of minimally invasive, endoseopie surgical procedures, including applications for endoscopic strip craniectomy. The current study prospectively evaluated the incidence of VAF during endoscopic strip craniectomy. Methods Continuous, intraoperative monitoring for VAE was performed using precordial Doppler monitoring. A recording was made of the Doppler tones and later reviewed to verify its accuracy. Results The cohort for the study included 50 consecutive neonates and infants ranging in age from 3.5 to 36 weeks and ranging in weight from 3 to 9 kg. Surgical time varied from 31 to 95 min for a total of 2,701 mm of operating time, during which precordial Doppler tones were auscultated. In 46 patients, there was no evidence of VAE. In four patients, there was a single episode of VAE. Two of the episodes of VAE were grade I (change in Doppler tones), and two were grade H (change in Doppler tones and decrease in end-tidal carbon dioxide). No grade III (decrease in systolic blood pressure by 20% from baseline) VAF was noted. Conclusion In addition to previously reported benefits of decreased blood loss, decreased surgical time, and improved postoperative recovery time, the authors noted a low incidence of VAF during endoscopic strip craniectomy in neonates and infants.

Sensitivity of End-tidal Nitrogen in Venous Air Embolism Detection in Dogs

1985 ◽  
Vol 63 (4) ◽  
pp. 418-423 ◽  
Author(s):  
J. Matjasko ◽  
P. Petrozza ◽  
C. F. Mackenzie
Keyword(s):  
Air Embolism ◽  
Venous Air Embolism ◽  
End Tidal

END-TIDAL NITROGEN AND VENOUS AIR EMBOLISM IN DOGS BREATHING N2O

1985 ◽  
Vol 63 (Supplement) ◽  
pp. A390
Author(s):  
Jane Matjasko ◽  
Gene Daffern ◽  
Bernard Marquis ◽  
Colin Mackenzie
Keyword(s):  
Air Embolism ◽  
Venous Air Embolism ◽  
End Tidal

The efficacy of Doppler monitoring for the detection of venous air embolism

1981 ◽  
Vol 54 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Philip L. Gildenberg ◽  
R. Patrick O'Brien ◽  
William J. Britt ◽  
Elizabeth A. M. Frost
Keyword(s):  
Doppler Ultrasound ◽  
Infusion Rate ◽  
Venous Pressure ◽  
Air Embolism ◽  
Physiological Changes ◽  
Central Venous ◽  
Content Type ◽  
Venous Air Embolism ◽  
Electrocardiographic Changes ◽  
End Tidal

✓ Venous air embolism can usually be detected by the use of a precordial Doppler ultrasound monitor at an air infusion rate as low as 0.015 ml/kg/min, and consistently at a rate of 0.021 ml/kg/min. This is in contrast to previously reported thresholds wherein the first physiological change, a gasp, occurs at 0.36 ml/kg/min, electrocardiographic changes first take place at 0.60 ml/kg/min, drop in blood pressure at 0.69 ml/kg/min, increased central venous pressure at 0.40 ml/kg/min, and end-tidal CO2 decreases at 0.42 ml/kg/min. The first change in heart sounds monitored through an esophageal stethoscope is not detectable until an air infusion rate of 1.70 ml/kg/min, and the classical mill-wheel murmur does not occur until 1.96 ml/kg/min. This demonstrates that Doppler ultrasound can detect venous air embolism before the earliest physiological changes, in contrast to most other methods which do not detect venous air embolism until after cardiopulmonary changes have become well established.

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