RSS-Feed abonnieren
DOI: 10.1055/s-0044-1779439
Paradoxical Air Embolism in Spinal Surgery: Case Report and Literature Review
Embolia gasosa paradoxal em cirurgia de coluna: Relato de caso e revisão de literatura Funding Statement No funding was received in any phase of the article's production.
Abstract
Air embolism (AE) is a subtype of embolism, caused by the entry of air into the vascular system. It is a predominantly iatrogenic complication, and its symptomatic form is severe, although uncommon. In some cases, a venous thrombi may pass into the arterial system through a venous-arterial shunt, characterizing a paradoxical embolism. Here, we describe the case of a previously healthy 44-year-old female who underwent cauda equina decompression and lumbar epidural abscess drainage. The patient suffered a paradoxical AE intraoperatively and died after 4 days. The occurrence of AE in lumbar spine surgeries in the prone position is rare, but the surgical team must be attentive to its clinical signs and quickly institute initial management when necessary.
Resumo
A embolia gasosa (EG) é um subtipo de embolia, causada pela entrada de ar no sistema vascular. É uma complicação predominantemente iatrogênica e sua forma sintomática é grave, embora incomum. Em alguns casos, um trombo venoso pode migrar para o sistema arterial através de um shunt venoso-arterial, caracterizando uma embolia paradoxal. Aqui, descrevemos o caso de uma mulher de 44 anos, previamente saudável, submetida a descompressão da cauda equina e drenagem de abscesso peridural lombar. A paciente sofreu uma EG paradoxal no intraoperatório e morreu 4 dias depois. A ocorrência de EG em cirurgias da coluna lombar em posição prona é rara, mas a equipe cirúrgica deve estar atenta aos seus sinais clínicos e, quando necessário, instituir o manejo inicial rapidamente.
Ethics Approval and Consent to Participate
Ethical approval was waived by the local Ethics Committee of the Faculdade Meridional - IMED in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The study was conducted in accordance with the declaration of Helsinki.
Consent for Publication
Informed consent forms were acquired from the patient's family, as the patient died before the article was written.
Availability of Data and Material
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Author Contributions
Each author made significant individual contributions to this manuscript. Miotto GJ: Main physician responsible for the patient's care and main surgeon; review of the manuscript's intellectual content; approval of the final version of the manuscript. Martio AE: Development and writing of the article; approval of the final version of the manuscript. Mesquita Filho PM: Development and writing of the article; approval of the final version of the manuscript. Karam OR: Physician responsible for the patient's care, auxiliary surgeon; writing of the article; approval of the final version of the manuscript. Padua WL: Critical review of the intellectual content of the manuscript; approval of the final version of the manuscript. Berres TO: Critical review of the intellectual content of the manuscript; approval of the final version of the manuscript. Ferreira Saltiél RM: Critical review of the intellectual content of the manuscript; approval of the final version of the manuscript.
Publikationsverlauf
Eingereicht: 03. Februar 2023
Angenommen: 04. August 2023
Artikel online veröffentlicht:
02. Mai 2024
© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Mirski MA, Lele AV, Fitzsimmons L, Toung TJ, Warltier David C. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007; 106 (01) 164-177 DOI: 10.1097/00000542-200701000-00026.
- 2 van Hulst RA, Klein J, Lachmann B. Gas embolism: pathophysiology and treatment. Clin Physiol Funct Imaging 2003; 23 (05) 237-246 DOI: 10.1046/j.1475-097x.2003.00505.x.
- 3 Muth CM, Shank ES. Gas embolism. N Engl J Med 2000; 342 (07) 476-482 DOI: 10.1056/nejm200002173420706.
- 4 Pronovost PJ, Wu AW, Sexton JB. Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 2004; 140 (12) 1025-1033 DOI: 10.7326/0003-4819-140-12-200406150- 00013.
- 5 Spence NZ, Faloba K, Sonabend AM, Bruce JN, Anastasian ZH. Venous air embolus during scalp incision. J Clin Neurosci 2016; 28: 170-171 DOI: 10.1016/j.jocn.2015.11.019.
- 6 Cruz AS, Moisi M, Page J. et al. Venous air embolus during prone cervical spine fusion: case report. J Neurosurg Spine 2016; 25 (06) 681-684 DOI: 10.3171/2016.5.spine16109.
- 7 Ho AM, Ling E. Systemic air embolism after lung trauma. Anesthesiology 1999; 90 (02) 564-575 DOI: 10.1097/00000542-199902000-00033.
- 8 Platz E. Tangential gunshot wound to the chest causing venous air embolism: a case report and review. J Emerg Med 2011; 41 (02) e25-e29 DOI: 10.1016/j.jemermed.2008.01.023.
- 9 Wong SS-M, Kwaan HC, Ing TS. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters. Clin Kidney J 2017; 10 (06) 797-803 DOI: 10.1093/ckj/sfx064.
- 10 Mishra R, Reddy P, Khaja M. Fatal Cerebral Air Embolism: A Case Series and Literature Review. Case Rep Crit Care 2016; 2016: 3425321 DOI: 10.1155/2016/3425321.
- 11 Durant TM, Long J, Oppenheimer MJ. Pulmonary (venous) air embolism. Am Heart J 1947; 33 (03) 269-281 DOI: 10.1016/0002-8703(47)90656-x.
- 12 Albin MS, Carroll RG, Maroon JC. Clinical considerations concerning detection of venous air embolism. Neurosurgery 1978; 3 (03) 380-384 DOI: 10.1227/00006123- 197811000–00009.
- 13 Bapteste L, Kamar Z, Mazaud A, Balança B. Air embolism during lumbar surgery in the prone position. Diving Hyperb Med 2021; 51 (03) 303-305 DOI: 10.28920/dhm51.3.303-305.
- 14 Pham Dang C, Péréon Y, Champin P, Delécrin J, Passuti N. Paradoxical air embolism from patent foramen ovale in scoliosis surgery. Spine 2002; 27 (11) E291-E295 DOI: 10.1097/00007632-200206010-00025.
- 15 McDouall SF, Shlugman D. Fatal venous air embolism during lumbar surgery: the tip of an iceberg?. Eur J Anaesthesiol 2007; 24 (09) 803-805 DOI: 10.1017/s0265021506002201.
- 16 Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Kudo D, Shimada Y. Intraoperative Visible Air Bubbling Recorded as a Sign of Massive Venous Air Embolism During Prone Position Surgery for Extensive Ossification of Spinal Ligaments: A Case Report with a Video Clip. World Neurosurg 2019; 131: 38-42 DOI: 10.1016/j.wneu.2019.07.166.
- 17 Durant TM, Oppenheimer MJ, Webster MR, Long J. Arterial air embolism. Am Heart J 1949; 38 (04) 481-500 DOI: 10.1016/0002-8703(49)90001-0.
- 18 Ho AM-H. Is emergency thoracotomy always the most appropriate immediate intervention for systemic air embolism after lung trauma?. Chest 1999; 116 (01) 234-237 DOI: 10.1378/chest.116.1.234.
- 19 DiStefano VJ, Klein KS, Nixon JE, Andrews ET. Intra-operative analysis of the effects of position and body habitus on surgery of the low back. A preliminary report. Clin Orthop Relat Res 1974; (99) 51-56 DOI: 10.1097/00003086- 197403000–00005.
- 20 Maddukuri P, Downey BC, Blander JA, Pandian NG, Patel AR. Echocardiographic diagnosis of air embolism associated with central venous catheter placement: case report and review of the literature. Echocardiography 2006; 23 (04) 315-318 DOI: 10.1111/j.1540-8175.2006.00211.x.
- 21 Moon RE. Hyperbaric treatment of air or gas embolism: current recommendations. Undersea Hyperb Med 2019; 46 (05) 673-683