title: Pathogenesis of systemic air embolism during bronchoscopic Nd:YAG laser operations.
abstract: BACKGROUND
  The occurrence of systemic air embolism during bronchoscopic neodymium:yttrium-aluminum garnet laser operations has been suspected. Here we describe its mechanism.
  
  
  METHODS
  Two patients with embolic cardiac and neurologic complications after bronchoscopic neodymium: yttrium-aluminum garnet laser tumor ablation are described. A subsequent third patient was monitored for intracardiac and aortic air by transesophageal echocardiography. A review of the literature and safety recommendations are discussed.
  
  
  RESULTS
  The appearance of systemic air emboli was related to the use of the laser fiber air coolant at high flow and resolved by decreasing the air flow. The presence of intracardiac and aortic air was associated with hypotension and inferior ischemic electrocardiographic changes.
  
  
  CONCLUSIONS
  Systemic air embolism during bronchoscopic laser operations is a potentially catastrophic complication and is related to the use of gas-cooled laser fibers and contact probes. We recommend using the noncontact mode whenever possible and maintaining the coaxial coolant air flow at the minimum level or using a fluid coolant if contact is necessary.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA. george.tellides@yale.edu
authors.forename: G
authors.initials: G
authors.lastname: Tellides
authors.forename: B S
authors.initials: BS
authors.lastname: Ugurlu
authors.forename: R W
authors.initials: RW
authors.lastname: Kim
authors.forename: G L
authors.initials: GL
authors.lastname: Hammond
mesh_terms: D000368:Aged; D000388:Air; D000538:Aluminum Silicates; D001018:Aortic Diseases / Q000000981:diagnostic imaging; D001984:Bronchial Neoplasms / Q000601:surgery; D001999:Bronchoscopy / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D004724:Endoscopy / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology; D053685:Laser Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017202:Myocardial Ischemia / Q000209:etiology; D009354:Neodymium; D012449:Safety; D018084:Ultrasonography, Interventional; D015019:Yttrium
chemical_list: D000538:Aluminum Silicates; D009354:Neodymium; D015019:Yttrium