scholarly journals Anesthetic challenges involved in successful resuscitation of a child from cardiac arrest secondary to massive hemorrhage and possible venous air embolism while undergoing fronto-orbital advancement surgery for metopic craniosynostosis

2021 ◽  
Vol 8 (2) ◽  
pp. 344-347
Author(s):  
Pawan Kumar ◽  
Gokuldas Menon ◽  
Nimish Danial ◽  
Mathew George
Keyword(s):  
Pulseless Electrical Activity ◽  
Air Embolism ◽  
Massive Hemorrhage ◽  
Neurological Deficits ◽  
Severe Bleeding ◽  
Operating Table ◽  
Successful Resuscitation ◽  
Venous Air Embolism ◽  
End Tidal ◽  
Metopic Craniosynostosis

A one year 3 month old child undergoing fronto-orbital advancement surgery for metopic craniosynostosis had severe bleeding when the surgeon attempted to remove bone flap. Head-end elevation was given at the surgeon’s request to reduce bleeding. Immediately there was a drastic fall in end tidal carbon dioxide (ETCO) and arterial saturation (SpO). Considering air embolism, fraction of inspired oxygen (FiO) was increased to 100% and the surgeon filled the field with saline and covered the area with wet gauze. The operating table was leveled. The child continued to deteriorate with the cardiac rhythm changing to pulseless electrical activity and asystole. Incremental bolus doses of adrenaline, blood products transfusion, fluid bolus and infusion of inotropes were given. Chest compression was not done as the endotracheal tube was fixed to the chest of the patient. Tube dislodgement without access to the head-end of the patient would have been a disaster. The child became hemodynamically stable, the surgery continued and the child was extubated the next day. Other than focal seizures which responded to levetiracetam, the child had no neurological deficits.

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.

297: SUCCESSFUL RESUSCITATION WITH HYPERBARIC OXYGEN THERAPY AFTER CATASTROPHIC VENOUS AIR EMBOLISM

2018 ◽  
Vol 46 (1) ◽  
pp. 131-131
Author(s):  
Emily Newman ◽  
Brian Fischer ◽  
Bjorn Olsen ◽  
Sameer Desai ◽  
Kevin Hatton
Keyword(s):  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Air Embolism ◽  
Successful Resuscitation ◽  
Venous Air Embolism

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.

Venous air embolism, hypotension, and end-tidal nitrogen

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 378???82 ◽  
Author(s):  
M J Matjasko ◽  
J Hellman ◽  
C F Mackenzie
Keyword(s):  
Air Embolism ◽  
Venous Air Embolism ◽  
End Tidal
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