title: [Air embolism during elective cesarean section, and uterine atony due to fetal macrosomia].
abstract: We report the case of a paradoxical air embolism during a scheduled cesarean section for fetal macrosomia (7.010 kg) in a 38-year-old woman with a history of gestational diabetes and preeclampsia. Spinal anesthesia was satisfactory and well tolerated. After approximately 30 minutes (coinciding with uterine exteriorization), the patient presented a sudden episode of dyspnea, confusion, hypotension, and ST segment depression. The episode lasted approximately 10 minutes and resolved spontaneously with no sequelae. Neurological status and the electrocardiogram were normal at the end of surgery and no postoperative lesions were observed. In the immediate postoperative period, the patient presented a massive hemorrhage due to uterine atony. Echocardiography revealed a patent foramen ovale. The clinical signs in this patient are highly suggestive of a paradoxical cerebral and coronary air embolism.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Maternal La Paz, Madrid.
authors.forename: F J
authors.initials: FJ
authors.lastname: Palacio
authors.forename: J R
authors.initials: JR
authors.lastname: Ortiz-Gómez
authors.forename: I
authors.initials: I
authors.lastname: Fornet
authors.forename: M A
authors.initials: MA
authors.lastname: López
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D004618:Embolism, Air / Q000209:etiology*; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D011247:Pregnancy; D014593:Uterine Inertia / Q000209:etiology*