The Australian Incident Monitoring Study. Air embolism--an analysis of 2000 incident reports.
There were 19 cases of air embolism (1%) among the first 2000 incidents reported to the Australian Incident Monitoring Study. No embolism-induced fatalities were reported. Serious acute systemic effects occurred in 14 incidents; one circulatory arrest required electrical counter-shock. The surgical field was the entry route for the air in 63% of the incidents; 47% of the cases occurred during head and neck surgery. Capnography was the most successful first detector (26%) and it confirmed the diagnosis in another 26%. Invasive blood pressure monitoring, the electrocardiograph and the pulse oximeter played a useful role in detecting and/or confirming air embolism. Doppler monitoring was not reported in this series. A successful first response for management included head-down posture, manual ventilation, 100% oxygen and control of the air entry site. Cerebral arterial gas embolism may induce vascular endothelial damage and possible delayed neurological sequelae; hyperbaric oxygen therapy should be considered.
Williamson
J A
JA
Department of Anaesthesia and Intensive Care, University of Adelaide, S.A.
Webb
R K
RK
Russell
W J
WJ
Runciman
W B
WB
D000758:Anesthesia / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D004618:Embolism, Air / Q000209:etiology*; D006801:Humans; D015994:Incidence; D012308:Risk Management / Q000379:methods*