Analysis of risk factors for venous air embolism in the semisitting position and its impact on outcome in a consecutive series of 740 patients

2021 ◽  
pp. 1-8
Author(s):  
Shadi Al-Afif ◽  
Hesham Elkayekh ◽  
Mazin Omer ◽  
Hans E. Heissler ◽  
Dirk Scheinichen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Air Embolism ◽  
Consecutive Series ◽  
Surgical Performance ◽  
Transthoracic Doppler Echocardiography ◽  
Venous Air Embolism ◽  
Arterial Blood

OBJECTIVE Routine use of the semisitting position, which offers several advantages, remains a matter of debate. Venous air embolism (VAE) is a potentially serious complication associated with the semisitting position. In this study, the authors aimed to investigate the safety of the semisitting position by analyzing data over a 20-year period. METHODS The incidence of VAE and its perioperative management were analyzed retrospectively in a consecutive series of 740 patients who underwent surgery between 1996 and 2016. The occurrence of VAE was defined by detection of bubbles on transthoracic Doppler echocardiography (TTDE) or transesophageal echocardiography (TEE) studies, a decrease of end-tidal CO2 (ETCO2) by 4 mm Hg or more, and/or an unexplained drop in systolic arterial blood pressure (≥ 10 mm Hg). From 1996 until 2013 TTDE was used, and from 2013 on TEE was used. The possible risk factors for VAE and its impact on surgical performance were analyzed. RESULTS There were 404 women and 336 men with a mean age at surgery of 49 years (range 1–87 years). Surgery was performed for infratentorial lesions in 709 patients (95.8%), supratentorial lesions in 17 (2.3%), and cervical lesions in 14 (1.9%). The most frequent pathology was vestibular schwannoma. TEE had a higher sensitivity than TTDE. While TEE detected VAE in 40.5% of patients, TTDE had a detection rate of 11.8%. Overall, VAE was detected in 119 patients (16.1%) intraoperatively. In all of these patients, VAE was apparent on TTDE or TEE. Of those, 23 patients also had a decrease of ETCO2, 18 had a drop in blood pressure, and 23 had combined decreases in ETCO2 and blood pressure. VAE was detected in 24% of patients during craniotomy before opening the dura mater, in 67% during tumor resection, and in 9% during wound closure. No risk factors were identified for the occurrence of VAE. Two patients had serious complications due to VAE. Surgical performance in vestibular schwannoma surgery was not affected by the presence of VAE. CONCLUSIONS This study shows that the semisitting position is overall safe and that VAE can be managed effectively. Persistent morbidity is very rare. The authors suggest that the semisitting position should continue to have a place in the standard armamentarium of neurological surgery.

scholarly journals Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

2007 ◽  
Vol 65 (3a) ◽  
pp. 605-609 ◽  
Author(s):  
Arquimedes Cavalcante Cardoso ◽  
Yvens B. Fernandes ◽  
Ricardo Ramina ◽  
Guilherme Borges
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Air Embolism ◽  
Cerebrospinal Fluid Leak ◽  
Surgical Removal ◽  
Venous Air Embolism ◽  
Craniotomy For Tumor Resection ◽  
Fluid Leak

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.

Cardiovascular Risk Factors and their Relationship with Endothelial Dysfunction in Rural and Urban South African Children

2020 ◽  
Author(s):  
Edna N. Matjuda ◽  
Godwill Azeh Engwa ◽  
Samuel Nkeh Chungag Anye ◽  
Benedicta N. Nkeh Chungag ◽  
Nandu Goswami
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Endothelial Dysfunction ◽  
Cardiovascular Risk Factors ◽  
High Blood Pressure ◽  
Urban Children ◽  
Urban Settings ◽  
Arterial Blood ◽  
Rural And Urban

Abstract Background: Endothelial dysfunction is known to be an initiator to the development and progression of atherosclerotic cardiovascular disease (CVD). However, there is paucity o knowledge on its relationship with cardiovascular risk factors in children. More so, some of these cardiovascular risk factors are known to be influenced by feeding habits and life style changes which often vary between rural and urban settings. This study was aimed to investigate the relationship between cardiovascular risk factors and endothelial function in rural and urban children. Methods: A cross-sectional study on 6-9 years old children in randomly selected rural and urban schools of the Eastern Cape Province of South Arica was conducted. General anthropometric indices were measured followed by blood pressure (BP) measurements. The pulse wave velocity (PWV) was measured using a Vicorder. Urine sample was collected for the determination of albumin, creatinine, asymmetric dimethylarginine (ADMA), 8-hydroxy-2deoxyguanosine (8-OHdG) and thiobarbituric acid reactive substance (TBARS). Albumin to creatinine ratio (ACR) was calculated.Results: Children from urban settings (10.8%) had a higher prevalence of overweight/obesity than their rural counterparts (8.5%) while the prevalence of elevated/high blood pressure was higher in rural children (23.2%) than in urban children (19.0%). Diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) significantly (p<0.005) increased with increasing quartiles of PWV. ADMA positively associated with HR in rural girls and showed a weak risk for elevated SBP and MAP. Body mass index (BMI) increased with increasing PWV and predicted endothelial dysfunction. 8-OHdG significantly (p<0.005) increased with increasing quartiles of ADMA and positively correlated with ADMA. Creatinine, albumin and ACR significantly (p<0.005) increased with increasing ADMA and ADMA associated positively with creatinine. Conclusion: Endothelial dysfunction was associated with obesity, high blood pressure, oxidative stress and microalbuminuria in children, and this relationship varied between rural and urban children.

Venous Air Embolism in Sitting and Supine Patients Undergoing Vestibular Schwannoma Resection

Neurosurgery ◽  
1998 ◽  
Vol 42 (6) ◽  
pp. 1282-1286 ◽  
Author(s):  
Derek A. Duke ◽  
James J. Lynch ◽  
Stephen G. Harner ◽  
Ronald J. Faust ◽  
Michael J. Ebersold
Keyword(s):  
Vestibular Schwannoma ◽  
Air Embolism ◽  
Venous Air Embolism

scholarly journals The semisitting position: analysis of the risks and surgical outcomes in a contemporary series of 425 adult patients undergoing cranial surgery

2017 ◽  
Vol 127 (4) ◽  
pp. 867-876 ◽  
Author(s):  
Andrea Saladino ◽  
Massimo Lamperti ◽  
Antonella Mangraviti ◽  
Federico G. Legnani ◽  
Francesco U. Prada ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Elective Surgery ◽  
Air Embolism ◽  
Adult Patients ◽  
Consecutive Series ◽  
Related Complication ◽  
Venous Air Embolism ◽  
Significant Statistical Difference ◽  
Increased Risk ◽  
Additional Option

OBJECTIVEThe objective of this study was to analyze the incidence of the primary complications related to positioning or surgery and their impact on neurological outcome in a consecutive series of patients undergoing elective surgery in the semisitting position.METHODSThe authors prospectively collected and retrospectively analyzed data from adult patients undergoing elective surgery in the semisitting position for a cranial disease. Patients were managed perioperatively according to a standard institutional protocol, a standardized stepwise positioning, and surgical maneuvers to decrease the risk of venous air embolism (VAE) and other complications. Intraoperative and postoperative complications were recorded. Neurointensive care unit (NICU) length of stay (LOS) and hospital LOS were the intermediate endpoints. Neurological outcome was the primary endpoint as determined by the modified Rankin scale (mRS) score at 6 months after surgery.RESULTSFour hundred twenty-five patients were included in the analysis. VAE occurred in 90 cases (21%) and it made no significant statistical difference in NICU LOS, hospital LOS, and neurological outcome. No complication was directly related to the semisitting position, although 46 patients (11%) experienced at least 1 surgery-related complication and NICU LOS and hospital LOS were significantly prolonged in this group. Neurological outcome was significantly worse for patients with complications (p < 0.0001).CONCLUSIONSEven in the presence of intraoperative VAE, the semisitting position was not related to an increased risk of postoperative deficits and can represent a safe additional option for the benefit of specific surgical and patient needs.

Contemporary Surgical Management of Vestibular Schwannomas: Analysis of Complications and Lessons Learned Over the Past Decade

2012 ◽  
Vol 72 (2) ◽  
pp. ons103-ons115 ◽  
Author(s):  
Yoichi Nonaka ◽  
Takanori Fukushima ◽  
Kentaro Watanabe ◽  
Allan H. Friedman ◽  
John H. Sampson ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Clinical Status ◽  
Neurological Complication ◽  
Tumor Resection ◽  
Hearing Preservation ◽  
Lessons Learned ◽  
Vestibular Schwannomas ◽  
Consecutive Series ◽  
Lower Cranial Nerve

Abstract BACKGROUND: Despite advanced microsurgical techniques, more refined instrumentation, and expert team management, there is still a significant incidence of complications in vestibular schwannoma surgery. OBJECTIVE: To analyze complications from the microsurgical treatment of vestibular schwannoma by an expert surgical team and to propose strategies for minimizing such complications. METHODS: Surgical outcomes and complications were evaluated in a consecutive series of 410 unilateral vestibular schwannomas treated from 2000 to 2009. Clinical status and complications were assessed postoperatively (within 7 days) and at the time of follow-up (range, 1–116 months; mean, 32.7 months). RESULTS: Follow-up data were available for 357 of the 410 patients (87.1%). Microsurgical tumor resection was performed through a retrosigmoid approach in 70.7% of cases. Thirty-three patients (8%) had intrameatal tumors and 204 (49.8%) had tumors that were &lt;20 mm. Gross total resection was performed in 306 patients (74.6%). Hearing preservation surgery was attempted in 170 patients with tumors &lt;20 mm, and good hearing was preserved in 74.1%. The main neurological complication was facial palsy (House-Brackmann grade III-VI), observed in 14% of patients (56 cases) postoperatively; however, 59% of them improved during the follow-up period. Other neurological complications were disequilibrium in 6.3%, facial numbness in 2.2%, and lower cranial nerve deficit in 0.5%. Nonneurological complications included cerebrospinal fluid leaks in 7.6%, wound infection in 2.2%, and meningitis in 1.7%. CONCLUSION: Many of these complications are avoidable through further refinement of operative technique, and strategies for avoiding complications are proposed.

Changes of EKG and Arterial Blood Gas during PEEP by Venous Air Embolism in Rabbits

1991 ◽  
Vol 24 (2) ◽  
pp. 332
Author(s):  
Joo Wan Kim ◽  
Jong Hun Jun ◽  
Jae Chul Shim ◽  
Kyoung Hun Kim ◽  
Dong Ho Lee ◽  
...  
Keyword(s):  
Air Embolism ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Venous Air Embolism ◽  
Arterial Blood

scholarly journals Risk Factors in Normal-Tension Glaucoma and High-Tension Glaucoma in relation to Polymorphisms of Endothelin-1 Gene and Endothelin-1 Receptor Type A Gene

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Dominika Wróbel-Dudzińska ◽  
Ewa Kosior-Jarecka ◽  
Urszula Łukasik ◽  
Janusz Kocki ◽  
Agnieszka Witczak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Intraocular Pressure ◽  
Clinical Condition ◽  
Type A ◽  
Normal Tension Glaucoma ◽  
Receptor Type ◽  
Endothelin 1 ◽  
Arterial Blood ◽  
High Tension

The aimof the research is to analyse the influence of polymorphisms of endothelin-1 gene and endothelin-1 receptor type A gene on the clinical condition of patients with primary open angle glaucoma.Methods. 285 Polish patients took part in the research (160 normal-tension glaucoma and 125 high-tension glaucoma). DNA was isolated by standard methods and genotype distributions of four polymorphisms in genes encoding endothelin-1 (K198N) and endothelin-1 receptor type A polymorphisms (C1222T, C70G, and G231A) were determined. Genotype distributions were compared between NTG and HTG groups. The clinical condition of participants was examined for association with polymorphisms.Results. A similar frequency of occurrence of the polymorphic varieties of the studied genes was observed in patients with NTG and HTG. There is no relation between NTG risk factors and examined polymorphisms. NTG patients with TT genotype of K198N polymorphism presented with the lowest intraocular pressure in comparison to GG + GT genotype (p=0.03). In NTG patients with CC genotype of C1222T polymorphism (p=0.028) and GG of C70G polymorphism (p=0.03) the lowest values of mean blood pressure were observed.Conclusions. The studied polymorphic varieties (K198N, C1222T) do have an influence on intraocular pressure as well as arterial blood pressure in NTG patients.

Incorporation of whole oat, especially bran, into a high-fat diet, improves cardio-metabolic risk factors in type 2 diabetic rats

2019 ◽  
Vol 49 (4) ◽  
pp. 600-616
Author(s):  
Fatima Bensalah ◽  
Nour el Imane Harrat ◽  
Fouad Affane ◽  
Hadjera Chekkal ◽  
Myriem Lamri-Senhadji
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
High Fat Diet ◽  
Metabolic Risk ◽  
High Fat ◽  
Content Type ◽  
Arterial Blood ◽  
Oat Bran

Purpose The purpose of this study was to determine the effects of whole oat, oat bran and refined oat incorporation in a high-fat diet (HFD) on cardio-metabolic risk biomarkers in rats with type 2 diabetes mellitus (T2DM). Design/methodology/approach T2DM was induced by feeding male rats with an HFD for 10 weeks, followed by a low dose of streptozotocin. T2DM rats were then divided into four homogeneous groups. Three groups consumed an HFD containing 45 per cent (g/100 g diet) whole oat, oat bran or refined oat. The fourth untreated group (control) received the HFD. Findings The results showed that whole oat and oat bran, compared with refined oat and control, effectively reduced food intake (p < 0.007), arterial blood pressure (p = 0.0001), glycemia (p < 0.001), insulinemia (p < 0.01), glycosylated haemoglobin (p < 0.001) as well as homeostasis insulin resistance (HOMA-IR) (p < 0.001). They also improved blood lipid levels and reverse cholesterol transport by reducing serum total cholesterol (p = 0.0001), triacylglycerols (p < 0.05), very-low- (p = 0.0001) and low-density lipoproteins cholesterol contents (p < 0.02) increasing lipids (p < 0.002) and cholesterol excretion (p = 0.0001), and high-density lipoprotein cholesteryl esters (HDL2-CE) concentrations (p = 0.0001) and stimulating lecithin: cholesterol acyltransferase (LCAT) activity (p = 0.0001). Moreover, they attenuated lipid peroxidation by increasing paraoxonase-1 (PON-1) atheroprotective activity (p < 0.05). Originality/value In T2DM rats, whole oat and particularly, its bran incorporated into an HFD improves arterial blood pressure, glycemic balance and lipid metabolic pathway by reducing hypertriglyceridemia and hypercholesterolemia and increasing atheroprotective activities of LCAT and PON-1. In contrast, refined oat accentuates the risk factors associated with diabetes.

scholarly journals Rate and reasons for elective ventilation in patients undergoing intracranial tumour surgery

2014 ◽  
Vol 01 (02) ◽  
pp. 125-130 ◽  
Author(s):  
Charu Mahajan ◽  
Girija Rath ◽  
Manish Sharma ◽  
Surya Dube ◽  
Vanitha Rajagopalan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Intraoperative Complications ◽  
Air Embolism ◽  
Perioperative Period ◽  
Neurological Status ◽  
Haemodynamic Instability ◽  
Intracranial Tumour ◽  
Venous Air Embolism ◽  
The Mean

Abstract Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 software. Categorical data was analysed using Chi-square test or Fisher's exact test and continuous data by Student's t-test. Results: A total of 709 patients enrolled for the study over a period of one year out of which 347 patients (48.9%) required continuation of MV during the postoperative period. The mean duration of MV was 29.7 ± 39.7 hrs. The most common causes for postoperative MV were ‘not responding to commands’ (43.2%), and neurosurgeon's advice (41.8%). The mean ICU and hospital stays were 92.2 ± 134.0 hrs and 13.8 ± 16.5 days, respectively. 47.6% of patients who required postoperative MV on neurosurgeon's advice developed complications whereas it was 33.2% for those ventilated other reasons (P < 0.05). Glasgow outcome scale (GOS) at discharge was poor in 12.4%. On multivariate analysis, intraoperative blood transfusion, tracheostomy and duration of ventilation more than 48 hrs were the independent risk factors associated with poor outcome. Conclusions: Although the neurosurgeon's advice for elective ventilation should not be ignored, but prolonged and avoidable MV may exacerbate the postoperative morbidities apart from increasing the cost of treatment. Hence, a complete understanding of intraoperative events, cerebral physiology and various factors influencing it during the perioperative period may not be overemphasised.

Body Mass Index and Cardiovascular Risk Factors in Children and Adolescents with High Birth Weight

2018 ◽  
Vol 72 (4) ◽  
pp. 272-278 ◽  
Author(s):  
Daniel L. Ledo ◽  
Fabíola Isabel Suano-Souza ◽  
Maria do Carmo P. Franco ◽  
Maria Wany L. Strufaldi
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Birth Weight ◽  
Children And Adolescents ◽  
Cardiovascular Risk Factors ◽  
Arterial Blood Pressure ◽  
High Birth Weight ◽  
Arterial Blood

Background/Aims: This study aimed to identify a possible association among high birth weight with overweight/obesity, high arterial blood pressure, dyslipidemia, and insulin resistance in children and adolescents. Methods: This is a cross-sectional study with 719 children and adolescents (6–12 years) stratified according to birth weight (low birth weight [LBW] <2,500 g, adequate birth weight [ABW] 2,500–3,999 g, and high birth weight [HBW] ≥4,000 g). Data collected were anthropometric data, arterial blood pressure levels, lipid profile, and insulin resistance (fasting glucose and insulin, used to calculate homeostatic model assessment-IR). Results: The mean age of schoolchildren was 9.5 ± 2.0 years and 371 (51.6%) were male. LBW and HBW were observed in 79 of 719 (10.9%) and 40 of 719 (55.6%) children/adolescents, respectively. There was no increased risk of overweight (OR 0.9; 95% CI 0.4–2.1; p = 0.964) and obesity (OR 1.4; 95% CI 0.6–3.5; p = 0.588) in HBW group compared to LBW and ABW groups. HBW was not associated with high blood pressure, dyslipidemia, and insulin resistance. The LBW group was independently associated with higher values of systolic (OR 1.07; 95% CI 1.05–1.10; p < 0.01) and diastolic blood pressure (OR 1.04; 95% CI 1.00–1.07; p = 0.044). Conclusion: There was no association between HBW with overweight/obesity and classic cardiovascular risk factors in this group of children/adolescents. Only LBW was related to higher blood pressure levels.

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