1/15. Cerebral air embolism and cerebral edema: one regimen of treatment.A case of cerebral air embolism responding immediately to compression to 6 atm is described. The patient, however, developed apparent cerebral edema while being decompressed. Subsequent recompression on oxygen was carried out twice daily at 60 ft (18 m, 2.8 ATA) for 60 min until the patient's symptoms had nearly cleared. While a number of other medications known to affect intracranial pressure were used, objective clinical improvement was noted only after hyperbaric oxygen. A question is raised of whether there is an association between the development of cerebral edema and the administration of intravenous 5% glucose in water.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/15. Delayed-onset cerebral arterial gas embolism in a commercial airline mechanic.A commercial airline mechanic was evaluated for right-sided hemianesthesia. Thorough diagnostic testing failed to identify a definitive etiology, and the mechanic was assessed as having symptoms of a left internal capsule lesion, likely from an ischemic event. On day 12 after symptom onset, he consulted a diving medicine specialist for clearance to continue recreational scuba diving. A thorough history revealed that the patient worked regularly in a compressed air environment of commercial aircraft and had experienced a rapid decompression approximately 48 h prior to onset of the hemianesthesia. The specialist considered pulmonary barotrauma-induced cerebral arterial gas embolism as a possible diagnosis. On day 13 he was treated with hyperbaric oxygen using Treatment Table VI, which produced immediate relief. Following three additional hyperbaric oxygen treatments in the next 11 d, he reported nearly total resolution of his symptoms. This occurrence is believed to be the second report of a cerebral arterial gas embolism in an aircraft mechanic or maintenance crewman and suggests that the latency between time of depressurization and the development of symptoms from a pulmonary barotrauma-induced cerebral arterial gas embolism may extend longer than previously believed.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/15. Near-fatal air embolism: fibrin sheath as the portal of air entry.Complications of central venous catheters occur in less than 1% of all insertions. Of these, pulmonary air embolism is a rare though often fatal complication. Possible mechanisms include opening of the line to the atmosphere during use and poor technique during insertion or removal. There has also been speculation that the presence of a fibrin sheath after removal might be a mechanism for air entry. We present a case of a near-fatal pulmonary air embolus with documentation of air in the pulmonary outflow trunk and a residual air-filled fibrin tract seen on computed tomography.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/15. Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report.PURPOSE: To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the patient gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in substantial bleeding, a suspected gas embolism, and emergency conversion of the procedure from laparoscopic to open donor nephrectomy. CLINICAL FEATURES: A 59-yr-old man - height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I - presented as kidney donor for laparoscopic donor nephrectomy. He was healthy, on no medication, and had no previous abdominal surgery or diseases of the urinary tract. The preoperative computed tomography (CT) scan evaluation of his kidneys confirmed this by reporting a normal bilateral renal and renal vascular anatomy. In contradiction to the preoperative CT scan findings, the surgeon discovered abnormalities in the operative field. This included extensive scarring surrounding the left kidney, adenopathy near the right hilum, and a large branch lumbar vein entering the renal vein. The large branch lumbar vein was clipped but the clips dislodged, causing significant blood loss, and a suspected gas embolus. The procedure was converted to an emergency open donor nephrectomy. Postoperatively the patient made a full recovery. CONCLUSION: Laparoscopic donor nephrectomies, though usually performed on healthy individuals, have their pitfalls, and complications during this procedure can be sudden and serious. As shown in this case, although CT scan results are regarded as reliable, they can be misleading. As an anesthetic precaution for possible gas emboli during laparoscopic procedures, nitrous oxide should be avoided and the patient be ventilated with 100% oxygen.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/15. Venous oxygen embolism produced by injection of hydrogen peroxide into an enterocutaneous fistula.We report a venous oxygen embolism that occurred in a 66-yr-old man after 60 mL of 3% hydrogen peroxide was injected into a perianal fistula intraoperatively to locate its internal opening. The diagnosis was made after detecting hypoxemia, decreased end-tidal carbon dioxide tension, systemic hypotension, increased central venous pressure, and a new heart murmur. The patient recovered quickly and had no long-term sequelae. oxygen embolism is a potentially fatal complication that can develop when hydrogen peroxide is used near venous spaces, and clinicians should be aware of the potential dangers when using this seemingly innocuous chemical.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/15. Emphysematous cystitis: rapid resolution of symptoms with hyperbaric treatment: a case report.INTRODUCTION: Emphysematous cystitis is a rare disease that occurs most often in elderly diabetic patients characterized by gas formation in the bladder wall due to infection. The infecting organism is usually an aerobic bacterium, most commonly E. coli although anaerobic species have also been reported. We report the use of hyperbaric oxygen in a patient with emphysematous cystitis and air in the femoral vein in which the treatment rapidly resolved the symptoms and radiological abnormalities. methods: A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness. urinalysis was positive for white blood cells and bacteria. A CT scan of the abdomen demonstrated extensive air in the bladder wall with an air bubble in the femoral vein. Presumptive diagnosis was urinary tract infection, emphysematous cystitis, and sepsis. A question of air embolism was raised due to the intravascular gas. The patient was treated with hyperbaric oxygen (2.85 atm abs, 90 minutes) on two separate occasions in the first 12 hours. Within 24 hours, the patient's condition rapidly improved. Repeat CT scan 48 hours after admission showed near complete resolution of the emphysematous cystitis. The patient grew klebsiella pneumonia from her urine. CONCLUSIONS: Emphysematous cystitis is a rare condition caused by either aerobic or anaerobic bacteria and may be associated with both bladder wall and intravascular gas formation. Hyperbaric oxygen therapy has not been previously reported as a treatment modality. The rapid improvement in our patient may indicate a role for hyperbaric oxygen in addition to IV hydration and antibiotics in this disease.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/15. Fatal scuba diving incident with massive gas embolism in cerebral and spinal arteries.CT and MRI have the potential to become useful adjuncts to forensic autopsy in the near future. The examination of fatal injuries facilitates a profound experience in the clinical-radiological examination of these cases; the more severe findings in corpses with autopsy verification can help one to understand the tiny signs seen in clinical cases of surviving victims. We present the case of a 44-year-old male diver who died from severe decompression sickness after rapid ascent from approximately 120 m. Post-mortem CT and MRI studies of the brain and spinal cord revealed extensive gas inclusions in cerebral arteries, spinal arteries and cerebrospinal fluid (CSF) spaces, while the intracranial venous sinuses remained unaffected. These findings were confirmed at autopsy. Appropriate imaging techniques can help forensic pathologists to aim their autopsies at findings that might otherwise remain undetected.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/15. Intraoperative visible bubbling of air may be the first sign of venous air embolism during posterior surgery for scoliosis.STUDY DESIGN: Case report of two children sustaining venous air embolism (VAE) during posterior surgery for scoliosis. OBJECTIVES: To report 2 cases where visible bubbling at the operative site was the first clinical indication of VAE-induced cardiovascular collapse and to raise the level of consciousness that VAE in the prone position can occur, often with serious consequences. SUMMARY OF BACKGROUND DATA: Twenty-two cases of VAE during surgery for scoliosis in the prone position have been reported. Ten were fatal and ten were in children. Visible bubbling at the operative site was noted in two published cases. methods: Retrospective study of 2 cases of VAE at one institution. Clinical, anesthetic, and radiographic features are presented. Details of previously published cases are reviewed and discussed. RESULTS: Both patients were girls with adolescent scoliosis who underwent prone positioned posterior spinal fusion with instrumentation. Visible bubbling of air at the thoracic aspect of the surgical site was noted near the completion of instrumentation and was the first indication of VAE. In both cases, this was clinically recognized and promptly treated. One patient survived normally and the other died. CONCLUSIONS: Visible air bubbling at the operative site may herald the onset of massive VAE during multilevel posterior spinal fusion and instrumentation. A prospective multicenter study using precordial Doppler, central venous catheter, and end-tidal CO2 is recommended to determine the true incidence of VAE in spinal deformity surgery and to evaluate monitoring and treatment methods.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/15. nitrogen embolus as a complication of hepatic cryosurgery.A case of near-fatal nitrogen embolism during hepatic cryosurgery is presented. Modifications of liquid nitrogen probes, which prevent direct contact of liquid nitrogen with the tissue being frozen, can prevent this type of injury.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/15. Air embolism following intra-uterine hypertonic saline instillation: treatment in a high-pressure chamber; a case report.Air embolism was encountered in a patient following induced abortion by means of intra-amniotic hypertonic saline instillation. The only symptom present was isolated cortical blindness. The patient was treated in a high-pressure chamber and a nearly complete recovery was achieved.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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