Vascular Air Emboli During the Perioperative Period
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PATIENT SAFETY IN ANESTHESIA (SJ BRULL, SECTION EDITOR)
Vascular Air Emboli During the Perioperative Period Ilana R. Fromer 1
&
Balazs Horvath 1 & Richard C. Prielipp 1 & Benjamin Kloesel 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Vascular air embolism is of particular concern to the anesthesiologist. The unique combination of factors encountered during procedures requiring sedation or general anesthesia increases the risk for its occurrence. Air embolism can have devastating consequences and result in morbidity and even mortality. Prevention and early diagnosis are key in mitigating the effects of this event. This manuscript provides a comprehensive review of the current knowledge and new developments in vascular air embolism. Recent Findings Our understanding of procedures during which vascular air embolism can occur has expanded. Increased implementation of transesophageal echocardiography (TEE) for non-cardiac surgeries has made echocardiography one of the most versatile intraoperative diagnostic methods. Treatment is mostly limited to prevention of further air entrainment, supportive care, and resuscitation. Summary Vascular air emboli can frequently be prevented using meticulous attention in handling indwelling vascular catheters and surgical technique. If, despite precautions, a vascular air embolus occurs, rapid diagnosis can aid in implementation of actions that prevent further air entrainment, support cardiopulmonary function, and mitigate the effect of the air embolus present in the vascular system. Keywords Venous air embolism (VAE) . Gas embolism . Complications of invasive procedures . Microemboli
Introduction Vascular air embolism (VAE) is an intensifying threat to patient safety because of the expanding spectrum of periprocedural and perioperative interventions that can enable
This article is part of the Topical Collection on Patient Safety in Anesthesia * Ilana R. Fromer [email protected] Balazs Horvath [email protected] Richard C. Prielipp [email protected] Benjamin Kloesel [email protected] 1
Department of Anesthesiology, School of Medicine, University of Minnesota, B515 Mayo Memorial Building, 420 Delaware St SE, Minneapolis, MN 55455, USA
gas entry into either the arterial or venous circulation. While it is fortunate that the majority of VAE events remain clinically asymptomatic, it also means they go largely undetected. However, VAE may result in catastrophic cardiovascular collapse and even death depending on the volume and the rate of gas entry, the site of entry, the distribution of gas emboli to vital organs, and pre-existing patient co-morbidities [1•]. While the exact incidence of such events remains unknown, it is better estimated for the specific procedures that carry the risk of vascular air embolism as adverse events, including the incidence of morbidity and mortality. For example, the estimated incidence of VAE is 0.2–1% during central venous catheterization, and it is up to 10–80% during posterior fossa craniotomy [2]. The
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