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Air embolism is acute embolism resulting from vaginal insufflation. It was first reported in 1936. There is no definite report of its incidence, but has been described in 18 mortalities out of 20 million pregnancies. When air is introduced under pressure, it travels through the dilated cervical canal and beneath the amniotic membranes, to enter the subplacental sinuses. Once air enters the venous drainage of the uterus, it reaches the inferior vena cava, and from there to the right side of the heart. Patients with venous air embolism (VAE) may present with a wide variety of symptoms. The most serious manifestation of VAE is out-of-hospital cardiac arrest. Laboratory abnormalities vary according to the severity of the embolism but lack specificity. The first line of treatment is advising pregnant females against orogenital sex with air insufflation. Accurate diagnosis is the key for managing VAE. Management starts with administration of 100% oxygen, then turning the patient onto her left side in a head-down position. In case of cardiovascular collapse, closed-chest compression is used to remove air trapped in the right side of the heart. Hyperbaric oxygen therapy has been proved to be an effective therapy as well.
This chapter, provides anoverview of the basics of pediatric neurological tumors. The author identifies the common tumor pathologies and presenting symptoms in children by anatomic region. The key anesthetic concerns present for posterior fossa tumor resection are presented. The chapter reviews the differentiation and treatment of Syndrome of Inappropriate Antidiuretic Hormone, diabetes insipidus and Cerebral Salt Wasting Syndrome.
The incidence of venous air embolism (VAE) during and following diagnostic and interventional radiographic procedures utilizing contrast media has been well documented in the literature. However to date a case report of a venous air embolism occurring within an outpatient healthcare facility during a contrast enhanced computer tomography radiation therapy planning procedure remains under reported.
Purpose
Healthcare professionals must remain alerted to the fact that iatrogenic VAE may occur unexpectedly during and following diagnostic and interventional radiographic procedures utilizing the injection of contrast media. The action by all healthcare professionals to implement rapid and clear acute care guidelines will increase the probability of the patient recovering from the event.
Materials and methods
A review of the aetiology and associated pathophysiology of VAE is provided. This is followed by a detailed case report of the occurrence of a non-fatal VAE event (patient consent was obtained and the consent form template was reviewed by a Research Ethics Board).
Conclusion
We conclude with a discussion of quality assurance recommendations that should be considered for implementation in an outpatient facility setting that is performing contrast enhanced computer tomography diagnostic, interventional or radiation therapy planning radiographic procedures.
A venous air embolism (VAE) is a potentially life-threatening event caused by air in the vascular system. The entrainment of air from an operative site into the venous vasculature produces a wide array of systemic effects. This chapter presents a case study of a 37-year-old female with a right-sided acoustic neuroma presenting for a suboccipital approach to tumor resection. VAE was historically most often associated with craniotomies performed in the sitting position. Clinical presentation depends on the severity of the air embolus. There are several monitors that are capable of detecting venous air emboli. The most sensitive is transesophageal echocardiography (TEE). The presence of TEE also enables direct visualization of air aspiration through a central catheter if a VAE should occur. Monitors for high-risk cases should be chosen depending on the expertise of the anesthesiologist, the surgery being performed, and the position of the patient.
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