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Surg Endosc 2019 Feb 15. Epub 2019 Feb 15.

Department of Surgery, St. Luke's Regional Medical Center, Boise, ID, USA.

Background: Gasketless laparoscopic insufflator systems are marketed for the ability to prevent desufflation of pneumoperitoneum during laparoscopy. However, surgeons raised concern for possible introduction of non-absorbable room air, including oxygen (O), with these systems. A community-university collaborative was created to test this hypothesis. Read More

Eur J Case Rep Intern Med 2019 23;6(1):001011. Epub 2019 Jan 23.

Internal Medicine Department, Hospital de Cascais, Cascais, Portugal.

Cerebral venous air embolism (CVAE) is an extremely rare phenomenon. Most reports of cerebral air embolism focus on the arterial territory, and consequently CVAE has remained poorly understood, especially regarding its pathophysiology and treatment. The authors describe an elderly male patient who was admitted through the Emergency Department with subacute confusion. Read More

2018 IEEE Conf Cogn Comput Asp Situat Manag CogSIMA (2018) 2018 Jun 2;2018:165-167. Epub 2018 Aug 2.

Medical Robotics Assisted Surg. Lab, VABHCS, Harvard Medical School, Boston, MA,USA.

To address the, currently unmet, need for intra-operative safety-critical cognitive support in cardiac surgery, we have developed, validated, and implemented a series of customized checklists to address intra-operative emergencies, using a simulated operative setting. These crisis checklists are designed to provide cognitive and communication support to the operative team to reduce the likelihood of adverse events and improve adherence to best-practice guidelines. We recruited a number of content specialists including members of the hospital safety network and intraoperative cardiac surgery team members, and utilized a Delphi consensus method to develop procedure-specific guidelines for select intraoperative crises. Read More

J Radiol Case Rep 2018 Aug 31;12(8):12-16. Epub 2018 Aug 31.

Department of Diagnostic Radiology, the University of Toledo Medical Center, Ohio, USA.

A case of a 52-year old male patient who presented to the emergency department with severe nausea and vomiting following accidental ingestion of H2O2. A computed tomography (CT) abdomen performed at our institution demonstrated extensive portal venous gas throughout the liver with few gas droplets seen in the extrahepatic portal vein portion. Pneumatosis was also noted in the wall of the gastric antrum. Read More

Tidsskr Nor Laegeforen 2019 01 7;139(1). Epub 2019 Jan 7.

J Vasc Bras 2018 Jul-Sep;17(3):215-219

Universidade do Estado do Rio de Janeiro (UERJ), Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brasil.

Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. Read More

Indian J Anaesth 2018 Dec;62(12):1002-1003

Department of Neuroanaesthesiology and Critical Care, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Forensic Sci Med Pathol 2019 Jan 11. Epub 2019 Jan 11.

Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.

A 16-month-old girl who was hospitalized with pneumonia and treated with antibiotics died after the nurse erroneously connected her intravenous left forearm catheter to the oxygen supply. Autopsy revealed an impressive gas embolism in the left subclavian and brachiocephalic veins, reduced crepitus and enlarged lung volume, and congestion of the meningeal vessels with some areas showing small air bubbles. Dilation of the right atrium and the right ventricle with efflux under pressure of large amounts of air bubbles were observed. Read More

Medicine (Baltimore) 2019 Jan;98(2):e14079

Department of Diagnostic Pathology.

Rationale: Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are rare but potentially lethal conditions in which gas pathologically accumulates in the portal vein and intestinal wall, respectively. Proposed mechanisms include flatus escaping through an injured intestinal mucosa into the submucosa and thence into the portal venous system, or bacterial translocation (BT) of gas-forming enteric microorganisms from the gut into and through the intestinal wall to other organs. However, there has been no clear histopathological evidence to support these hypotheses. Read More

J Community Hosp Intern Med Perspect 2018 11;8(6):376-379. Epub 2018 Dec 11.

Department of Medicine, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA.

Heparin Induced thrombocytopenia (HIT) is a rare, immune-mediated complication of heparin, associated with both thrombocytopenia and paradoxical thrombotic events. Initial diagnosis is made clinically when platelet count falls by 30% to <100 × 10cells/l or a > 50% decrease from baseline count in association with heparin therapy. Thromboembolic complications are seen in 50% of the cases. Read More

Can J Anaesth 2018 Dec 12. Epub 2018 Dec 12.

Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France.

Eur Rev Med Pharmacol Sci 2018 Nov;22(22):7916-7919

Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

We performed a systematic review of the literature starting from a real case of venous air embolism (VAE) in a young infant undergoing central catheterization during procedural sedation. Air embolism due to internal jugular vein catheterization during procedural sedation is very rare, but it is a potentially life-threatening complication of central catheterization that warrants attention. To our knowledge, this is the first case published in a similar scenario. Read More

J Intensive Care Soc 2018 Nov 1;19(4):354-356. Epub 2018 Mar 1.

North Bristol NHS Trust, Southmead Hospital, Bristol, UK.

We describe the first case of venous air embolism during percutaneous tracheostomy performed during continuous renal replacement therapy with citrate anticoagulation. Venous air embolism is a known risk during percutaneous dilatational tracheostomy; concurrent use of extracorporeal circuits may present a compounded risk due to the negative pressure developed by the blood pump. Use of regional citrate anticoagulation, permitting invasive procedures to be performed without discontinuing renal replacement therapy, may lead to an increase in the incidence of venous air embolism during tracheostomy. Read More

J Belg Soc Radiol 2018 Oct 18;102(1):68. Epub 2018 Oct 18.

Department of Surgery, First Faculty of Medicine, Charles University in Prague, CZ.

We report an unusual case of fatal air embolism into the superior mesenteric artery in a patient, who underwent replacement of the ascending aorta for aortic dissection type A. CT performed twice on the first postoperative day showed abundant air in the superior mesenteric artery and its branches (but not in the portal-venous system) indicating air embolism with no signs of bowel necrosis. On the second postoperative day, the patient underwent extensive bowel resection due to bowel ischemia and died on the third postoperative day on MODS/SIRS. Read More

J Clin Monit Comput 2018 Nov 22. Epub 2018 Nov 22.

Stanford University School of Medicine, Palo Alto, CA, USA.

Venous air-embolism (VAE) potentially catastrophic complication surgery. Based on previous data using changes in end-tidal nitrogen as an indicator of VAE, we surmised that changes in end-tidal argon (EtAr) may be an indicator of VAE. We sought to determine if a commercial mass-spectrometer (PCT Proline Analyzer 61700-8 Class 85, Ametek, Pittsburgh, PA 15238) could be used to detect changes in EtAr in an invitro model. Read More

N Engl J Med 2018 Nov;379(21):e37

Peking Union Medical College Hospital, Beijing, China

Medicine (Baltimore) 2018 Nov;97(47):e13368

Department of General and Gastroenterological Surgery.

Rationale: Hepatic portal vein gas (HPVG) is known as a sign of a lethal condition resulting from bowel necrosis. Recently, the detection rate of non-life-threatening cases of HPVG has increased due to the technological development of imaging, i.e. Read More

Int J Sports Med 2019 Jan 20;40(1):31-37. Epub 2018 Nov 20.

German Sport University, Institute of Physiology and Anatomy, Cologne, Germany.

Circulating venous bubbles after dives are associated with symptoms of decompression sickness in adults. Up to now it is not known to what extent children and adolescents are subjected to a bubble formation during their shallow dives and if there are possible indications for that. The aim of this pilot study is to investigate whether bubbles and/or symptoms occur after standardised repeated dives performed by young divers. Read More

Perioper Med (Lond) 2018 8;7:23. Epub 2018 Nov 8.

3Department of Pediatrics, NYU Langone Health, School of Medicine , New York, NY USA.

Background: Intravascular air embolism (AE) is a preventable but potentially catastrophic complication caused by intravenous tubing, trauma, and diagnostic and surgical procedures. The potentially fatal risks of arterial AE are well-known, and emerging evidence demonstrates impact of venous AEs on inflammatory response and coagulation factors. A novel FDA-approved in-line air detection and purging system was used to detect and remove air caused by administering a rapid fluid bolus during surgery. Read More

Br J Anaesth 2018 Dec 17;121(6):1215-1217. Epub 2018 Oct 17.

Norfolk and Norwich University Hospital, Department of medicine, Norwich, UK.

A man with neuromuscular respiratory failure requiring intubation and ventilation suffered a venous air embolism during inadvertent administration of 5 ml of air. Ultrasound (US) imaging confirmed an air embolus in the left subclavian vein, which was only partially treated by US-guided aspiration. The embolus completely resolved on US imaging during hyperbaric oxygen therapy, and the patient recovered with no complications secondary to the embolism. Read More

Perfusion 2018 Oct 19:267659118806120. Epub 2018 Oct 19.

Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.

Background And Objective: A multi-discipline cardiac and cardiopulmonary bypass (CPB) team simulation scenario was established to compare three different de-airing approaches dealing with massive air embolism in CPB, so as to formulate a standardized procedure to handle this adverse acute event more proficiently and ensure clinical safety.

Method: A simulation-based clinical CPB massive air embolism scenario was developed by a cardiac and CPB team. Study Objects: Five licensed perfusionists and five CPB trainees were matched randomly into five pairs. Read More

Oper Neurosurg (Hagerstown) 2019 Mar;16(3):E79

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

In this video, we present the case of a 41-yr-old female with new onset of recurrent syncopal episodes. She underwent extensive evaluations and diagnostic work-up by cardiology and neurology, excluding any other cause than a large pineal cyst that was found on magnetic resonance imaging.  Surgical indications for pineal cyst resection are very limited as most pineal cyst can be treated conservatively. Read More

Medicine (Baltimore) 2018 Sep;97(39):e12639

Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.

Rationale: Although venous air embolism (VAE) during liver operation has been reported occasionally, fatal VAE in hepatic resection is uncommon. Prompt detection of VAE by transesophageal echocardiography (TEE) is crucial for effective therapy. We describe a case of fatal VAE that caused repeated cardiac arrest during hepatic resection and was confirmed by TEE. Read More

J Thromb Haemost 2018 Dec 15;16(12):2397-2402. Epub 2018 Oct 15.

Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.

Essentials In acute pulmonary embolism (PE), risk stratification is essential to drive clinical management. Improving the 2014-ESC risk stratification strategy is crucial in hemodynamically stable patients. Oxygen saturation and respiratory rate improve risk stratification in hemodynamically stable PE. Read More

World Neurosurg 2018 Dec 21;120:405-414. Epub 2018 Sep 21.

Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. Electronic address:

An understanding of the anatomy and function of the skull base venous channels is fundamentally important for safe performance of endoscopic surgery for skull base lesions. This review focuses on 4 skull base venous channels-namely, the intercavernous sinuses, basilar plexus, osseous veins, and inferior petroclival vein-because these have been less recognized by neurosurgeons than other major venous channels such as the inferior petrosal sinus. We reviewed the literature concerning these 4 venous channels and discussed their anatomy and function. Read More

Radiol Case Rep 2018 Dec 11;13(6):1093-1096. Epub 2018 Sep 11.

University of California-Davis, Sacramento, CA, USA.

The incidence of cerebral infarction following upper gastrointestinal endoscopic procedures is well described in the existing literature, with most mechanisms involving arterial travel of the embolus. We describe a case of cerebral infarction not explained by previously described mechanisms and detail the proposed occurrence of retrograde venous air embolism causing cerebral infarction following an upper gastrointestinal endoscopic procedure. Read More

BMJ Case Rep 2018 Sep 15;2018. Epub 2018 Sep 15.

Department of Internal Medicine, Kantonsspital Graubunden, Chur, Switzerland.

We present a case of a young male patient with a fatal pulmonary air embolism following a penetrating gunshot head injury. He suffered from severe head trauma including a laceration of the superior sagittal sinus. Operative neurosurgical intervention did not establish a watertight closure of the wounds. Read More

World J Clin Cases 2018 Sep;6(9):274-278

Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, School of Medicine, Kangwon National Univerity, Chuncheon 24289, South Korea.

Systemic air embolism through a bronchovenous fistula (BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism through a BVF in patients undergoing extracorporeal membrane oxygenation (ECMO). Positive-pressure ventilation and ECMO support in patients with lung injury can increase the risk of systemic air embolism through a BVF. Read More

Diving Hyperb Med 2018 Sep;48(3):132-140

French Navy Diving School, Toulon, France.

Introduction: Ultrasonic detection of venous gas emboli (VGE) in the precordial (PRE) region is commonly used in evaluation of decompression stress. While subclavian (SC) VGE detection can also be used to augment and improve the evaluation, no study has rigorously compared VGE grades from both sites as decompression stress indicators.

Methods: This retrospective study examined 1,016 man-dives breathing air extracted from the Defence Research and Development Canada dataset. Read More

Int J Crit Illn Inj Sci 2018 Jul-Sep;8(3):176-178

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Jeju National University Hospital, Jeju National University, Jeju, Korea.

Air embolism is a rare but mostly iatrogenic complication of medical or surgical procedures and may have a serious outcome. On the removal of a central venous catheter (CVC), minor carelessness can lead to a venous air embolism sometimes accompanied by arterial embolism. We experienced the case of a 61-year-old male who suffered from a paradoxical systemic air embolism while we removed a CVC. Read More

Surg Neurol Int 2018 10;9:160. Epub 2018 Aug 10.

Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.

Background: Nowadays, the sitting position has lost favor among neurosurgeons partly due to assumptions of increased complications, such as venous air embolisms (VAEs) and hemodynamic disturbances. The aim of our study is to describe the importance of some anesthetic considerations and the utility of antigravity trousers as well, together with a skillful neurosurgery and an imperative proper teamwork, in order to prevent the risk of severe VAE during pineal region surgery. We routinely use them for the variant of the sitting position we developed, the "praying position. Read More

Kurume Med J 2018 Dec 30;65(1):17-21. Epub 2018 Aug 30.

Department of Radiology, Kurume University School of Medicine.

Cerebral air embolism following central venous catheter (CVC) removal is extremely rare. We report a case of cerebral air embolism with loss of consciousness after removal of CVC caused by pulmonary arteriovenous malformation (PAVM). Computed tomography revealed air bubbles in the internal carotid arteries along the sulci in the cerebral hemispheres, as well as a PAVM. Read More

J Neurosurg Anesthesiol 2018 Aug 24. Epub 2018 Aug 24.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

Background: Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. Read More

BMJ Case Rep 2018 Aug 16;2018. Epub 2018 Aug 16.

Department of Neurology, CAMC Health System, Charleston, West Virginia, USA.

Cerebral air embolism (CAE) is a rare, avoidable and potentially fatal iatrogenic complication. Here, we report a case of CAE associated with a central venous catheter in the internal jugular vein that resulted in neurological deficits and generalised epileptic seizures. A 64-year-old man admitted for fasciotomy for compartment syndrome developed CAE with left-sided neurological deficits. Read More

J Clin Anesth 2018 Dec 7;51:49-54. Epub 2018 Aug 7.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55902, USA. Electronic address:

Study Objective: Determine if changes in expired carbon dioxide tension correlate with the severity of venous air embolism (VAE) associated hemodynamic changes in humans.

Design: Retrospective case series.

Setting: A single academic medical center with high-volume neurosurgical practice. Read More

Case Rep Crit Care 2018 8;2018:5808390. Epub 2018 Jul 8.

Anesthesia and Intensive Care Department, Cattinara Hospital, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.

Many different risk factors have been associated with the occurrence of gas embolism making this potentially lethal complication easily avoidable. However, this condition can occur in circumstances not commonly reported. Three different and extremely uncommon cases of gas embolism are presented and discussed: the first was caused by the voluntary ingestion of hydrogen peroxide, the second occurred during a retrograde cholangiopancreatography, and the last followed the intrapleural injection of Urokinase. Read More

Anesth Analg 2018 Aug;127(2):324

Vanderbilt University School of Medicine Northwestern University Feinberg School of Medicine

BMJ Case Rep 2018 Jul 18;2018. Epub 2018 Jul 18.

Internal Medicine Residency Program, McLaren Health Care Corporation, Flint, Michigan, USA.

Ann Thorac Cardiovasc Surg 2018 Oct 11;24(5):230-237. Epub 2018 Jul 11.

Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.

Purpose: Cardiac surgery with the use of extracorporeal circulation is associated with a significant risk for gaseous microemboli (GME) despite excellent surgical techniques and highest operative standards. GME are associated with postoperative neurocognitive dysfunction and negative clinical outcome. This study determines whether oxygenator design has influence on perioperative outcome after cardiac surgery. Read More

BMJ Case Rep 2018 Jul 5;2018. Epub 2018 Jul 5.

Pediatric Gastroenterology, Stony Brook Children's Hospital, Stony Brook, New York, USA.

Hepatic portal venous gas is the presence of gas within the portal vein and its branches. A 4-week-old male infant presented with 1-week history of non-bloody, non-bilious projectile emesis. Examination was significant for an olive-shaped mass in the abdomen. Read More

J Neuroophthalmol 2018 Dec;38(4):486-487

Departments of Ophthalmology (MR-T, NV, AWH) and Radiology (AV), Royal Hobart Hospital, Hobart, Australia; and Menzies Research Institute (NV, AWH), Hobart, Australia.

An asymptomatic air embolism in the right superior ophthalmic vein was discovered incidentally during a cerebral computed tomography, most likely due to a preceding intravenous fluid bolus. This case illustrates the potential risk of air emboli being propagated to the cerebral venous circulation during routine injections and fluid resuscitation. Read More

Forensic Sci Med Pathol 2019 Mar 11;15(1):122-124. Epub 2018 Jun 11.

Forensic Science SA, 21 Divett Place, Adelaide, South Australia, Australia.

Deep vein thrombosis resulting in lethal pulmonary thromboembolism is not-infrequently encountered in forensic cases. Predisposing factors include immobility, recent surgery, previous deep venous thromboses/pulmonary thromboembolism, indwelling central venous lines, major trauma, the oral contraceptive pill, pregnancy, congenital cardiac disease, sepsis, malignancy, systemic lupus erythematosus, renal failure and certain inherited thrombophilias. Venous thrombosis associated with air travel was reported in the early 1950's and called the "economy class syndrome", although it is now recognized that reduced movement on long distance flights is more significant than seating class. Read More

Anesth Analg 2018 Aug;127(2):420-423

From the Departments of Anesthesiology and Perioperative Medicine.

Background: Known complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, bleeding, duodenal perforation, and venous air embolism (VAE). The aim of this study was to determine the incidence of VAE during ERCP and be able to differentiate high-risk versus low-risk ERCP procedures.

Methods: This is a prospective cohort study consisting of patients who underwent ERCP and were monitored with a precordial Doppler ultrasound (PDU) for VAE. Read More

Zh Vopr Neirokhir Im N N Burdenko 2018 ;82(3):36-41

Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047.

Posterior cranial fossa tumors are the most common neuro-oncological pathology of childhood. More than half of them are located along the midline, occupying the cerebellar vermis and 4th ventricle cavity. Historically, most of these tumors were operated on with the patient in sitting position. Read More

Paediatr Anaesth 2018 07 30;28(7):647-653. Epub 2018 May 30.

Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands.

Objective: The aim of this study was to evaluate pre-, intra-, and postoperative anesthetic parameters in endoscopic strip craniectomy in order to improve anesthesiological care.

Materials And Methods: This is a retrospective patient cohort study of our first 121 patients treated by endoscopic strip craniectomy. Preoperative as well as intra- and postoperative anesthesiological and neurological parameters were analyzed. Read More

Trials 2018 May 24;19(1):292. Epub 2018 May 24.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Background: The cross-sectional area of the subclavian vein (csSCV) is an important factor determining the success rate of SCV catheterization. The head-down position increases the csSCV. However, the effects of lateral tilting on subclavian venous cross-sectional area have not yet been explored. Read More

Can J Neurol Sci 2018 07 11;45(4):464-465. Epub 2018 May 11.

Department of Radiology,Uijeongbu St. Mary's Hospital,College of Medicine,The Catholic University of Korea,Gyeonggi-do,Korea.

Case Rep Emerg Med 2018 14;2018:9496818. Epub 2018 Mar 14.

Thomas Jefferson University Hospital, 1020 Sansom Street, Room 1651, Thompson Building, Philadelphia, PA 19107, USA.

Cerebral air embolism is a known complication from a myriad of iatrogenic causes. This case describes a 60-year-old female presenting from hemodialysis with altered mental status, bilateral homonymous hemianopia, and repetitive speech. A noncontrast head CT revealed air in the vein of Galen and the deep cerebral veins of the left thalamus and occipital sulcus, a complication from air being introduced into the patient via improper flushing of dialysis tubing. Read More