Acute Lung Injury Secondary To Venous Air Embolism Following Removal of Vascular Cathete
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Air embolism
Vascular occlusion
Objective To study the application and efficacy of hemihepatie vascular occlusion in HCC resection. Methods 90 ca-ses of HCC patients were roiled in and divided into two groups. Liver resection was performed with Pringle maneuver or hemihepatic vascular occhusion. Ischemia time, operative time, blood loss, postoperative liver function, the occurrence of complications and the recovery of gastro-intestinal function were recorded. The efficacy of the two occlusions was compared. Results There is no significant difference between hemibepatic vascular occlusion and Pringle maneuver in ischemia time, operative time, blood loss (P>0.05). However, there is signifi-cant difference in postoperative liver function, the occurrence of complications and intestinal function recovery time. The former is significant-ly superior to the latter (P<0.05). Conclusions The bemihepatic vascular occlusion and Pringle maneuver occlusion have no difference in ischemia time, operative time and blood loss. But bemihepatic vascular occlusion has less impact on liver function, lower rate of occur-rence of complications and faster recovery speed. Therefore, hemibepatie vascular occlusion is better than Pfingle maneuver occlusion in be-parle inflow occlusion in HCC surgery.
Key words:
Liver neoplasms/SU; Hepatectomy/MT
Vascular occlusion
Liver function
Liver Cancer
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Objective To investigate the intra-and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO),hemihepatic vascular occlusion (HVO),and selective vascular occlusion(SVO).Methods Retrospective analysis the data of 41 cases of laparoscopic liver resection were conducted in three groups of patients under different occlusion methods,including 15 cases of intermittent total pedicle occlusion (IPO),12 cases of hemihepatic vascular occlusion (HVO) and 14 cases of selective vascular occlusion (SVO).Intraoperation blood loss,operation time,conversion to open operation,changes in postoperative liver function,hospital stays and complications were compared among the three methods.Results There was no operative death in any of the 41 patients.There was no conversion to open surgery.Generally,there was no significant difference among the three groups in blood loss,clamping time or operative time.Ten patients had postoperative complication and all were cured.The effect on liver function for Gro-HVO and Gro-SVO was significantly less severe than that for Gro-IPO (P ＜ 0.05) after operation.Conclusions Both HVO and SVO are feasible and safe in laparoscopic hepatectomy(LH),and have advantage in reducing liver remnant ischemia injury and modality rate over IPO.HVO is easy to do for left lateral lobe or resection of the left half of the liver.SVO is suitable for right lobe resection.
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Laparoscopic ; Hepatotectomy ; Blood flow occlusion ; Liver neoplasms
Vascular occlusion
Liver function
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Hepatectomy is the main option of treatment for liver cancer,and how to control the blood loss is an important issue for the recovery of patients.Continuous hepatic vascular occlusion(Pringle maneuver)is the oldest and simplest way for vascular occlusion and still used in clinical practice.But continuous hepatic vascular occlusion often gives rise to postischemic reperfusion injury due to clamping the portal vein and the hepatic artery in the hepatic pedicle.So intermittent clamping or hemihepatic vascular occlusion is recommended in complex liver resections or for patients with liver cirrhosis.Total hepatic vascular exclusion has the advantages of occlusion of vascular inflow and outflow of the liver,and is mainly used for patients with tumors invading the caval veins.Major hepatic veins and limited inferior vena cava reconstruction has been also achieved under inflow occlusion with extraparenchymal control of major hepatic veins.It is crucial to know how to select the optimal methods of hepatic vascular occlusion according to the specific conditions.Focusing on this issue,we have reviewed and evaluated various methods and relevant researches in this paper.
Key words:
Liver neoplasms; Hepatectomy; Vascular occlusion
Vascular occlusion
Hepatic veins
Liver Cancer
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Iatrogenic gas embolism is the presence of gas in vascular structures. Feared are those in coronary or cerebral arteries. These can result in cerebral or myocardial infarction.
Air embolism
Oxygen therapy
Intracranial Embolism
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Objective To review the advances in techniques of hepatic blood occlusion in hepatectomy.Methods The related literatures were reviewed and analysed.Results There were many techniques of hepatic blood occlusion.The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion.Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged.Total vascular exclusion and other techniques were rarely used.Conclusion To reduce blood loss in hepatectomy and make patient safe,based on the situation of the patient,the technique should be ingeniously selected.
Vascular occlusion
Hepatic veins
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Gas bubbles present in an animal were first described by Boyle in 1670. Boyle claimed that air bubbles were formed due to a rapid pressure decrease in the decompression chamber, in which the animal was placed. Moreover, he described blood flow abnormalities and tissue hypoxia caused by air emboli located in the tiny vessels. In 1934, Chase described the two-phase nature of the vascular reaction induced by air bubbles. Some years later, Durant explained in detail the mechanism of mechanical vessel closure combined with vascular spasm in the pathogenesis of tissue hypoxia due to air embolism [1]. Three hundred and forty years after the pioneer works of Boyle, rapid development of medicine multiplied the risks of air embolism. Undoubtedly, any invasive medical procedure, endangering the vascular continuity, is associated with the risk of gas entry to the bloodstream. Some treatment methods are particularly risky in terms of such complications, e.g. neurosurgical procedures in the posterior cranial cavity, which 15-20 years ago were performed with patients placed in reclining positions. According to some authors, the risk of air embolism in a patient operated on in such a condition is even 20-40% [2]. The more recent publications suggest lower percentages, i.e. about 9%. Air embolism related to abdominal surgical procedures under pneumoperitoneum occurs in even 70-100% of patients [4, 5]. This is obviously a different issue due to the use of CO2; nevertheless, the link is the risk of massive gas penetration to the vascular bed. In 37.5% of cases, this results in haemodynamic disturbances [4]. Moreover, orthopaedic surgical procedures are associated with the risk of embolic complications; in some of them, air is the embolic material [6]. The largest group of patients at risk of air embolism includes those undergoing cardiac surgeries with extracorporeal circulation. Air bubbles are detected on transoesophageal echocardiography even in 79% of patients after heart valve surgeries and in 11% of aortocoronary bypass patients [7]. Some part of embolic gas material passes to the systemic circulation when the aorta camping is removed and haemodynamically efficient heart action is restored. There are no doubts that intravascular gas emboli are associated with the risk of organ injuries, especially neurologic complications. Furthermore, nobody questions the fact that hyperbaric oxygen therapy is the most effective method of treatment of massive air embolism. According to Dexter, hyperbaric oxygenation should be always considered when the air bubbles are detectable on the brain CT scan [8]. Moreover, it is known that the therapy should be started as early as possible, although some believe that delayed institution is also associated with improvement of neurological condition. The incidence of air embolism cases seems definitely understated. The majority of cases are likely to present no explicit clinical manifestations, which is associated with moderate severity of the process and spontaneous absorption of air when its amount is low. Indeed, in the case described there was the risk of severe neurologic sequels. However, the patient’s general condition improved quickly and 2 h after the embolic episode verbal, logical communication with the patient was established. The in-depth neurological examination did not reveal any symptoms of focal brain damage.
Air embolism
Cranial cavity
Hypoxia
Decompression Illness
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Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism.We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers.Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made.The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation.Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities.While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.
Air embolism
Circulatory collapse
Oxygen therapy
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Based on the literature data, the discussion covers the causes, preventive measures, and treatment of massive arterial air embolism, which is one of the most dangerous complications of artificial circulation (AC). Cerebral retroperfusion, hyperbaric oxygenation, low-temperature AC, and long-term administration of antihypoxic agents in the postoperative period have been considered most effective in the management of air embolism. The authors present their experience of successful management of four massive arterial air embolism cases, which is 0.22 percent of AC-assisted operations performed since 1984. Combined retrograde cerebral reperfusion and hypothermic AC have been used in the cases under discussion. Since it is impossible to determine the extent of embolism-associated brain damage and the limits of reliability of the applied therapy, it is essential in each embolism case to make use of all therapeutic means that are available in the given situation to combat this grave complication.
Air embolism
Extracorporeal circulation
Intracranial Embolism
Hyperbaric oxygenation
Arterial embolism
Cerebral embolism
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Air embolism occurred in a 25-year-old patient undergoing surgery for reconstruction of the subclavian vein. Air embolism probably occurred twice, the second time at about an hour after closure of the vein. The cause of this delayed air embolism is discussed. We conclude that capnographic monitoring for air embolism is advisable whenever surgery is performed on a patient in the half-sitting position, and that inserting a central venous catheter to facilitate removal of the air in the event of massive air embolism may be wise.
Air embolism
Sitting
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The influences of intermittent hemihepatic vascular occlusion in rats were investigated. The restoration of tissue energy level during 10 min of reperfusion after more than 40 min of occlusion was significantly lower than after occlusion within 30 min. over 40 min of occlusion which resulted in a significant increase of tissue free fatty acids during occlusion showed marked decrease of total adenine nucleotides (TAN) in the liver and marked increase of serum TAN in the hepatic vein after reperfusion. It was presumed that these findings were caused by wash-out of adenine-nucleotides from liver cell to the hepatic vein after reperfusion correlated with degradation of cell membrane. Thus, less than 30 min of occlusion was safe in hemihepatic vascular occlusion. Three times intermittent occlusion--repeats of 30 min of occlusion and 10 min of reperfusion--resulted in a same tissue energy level as once 40 min of occlusion. Furthermore, there was no difference in serum ornithine carbamoyltransferase, tissue oxygen consumption and ICG test during 48 hrs after reperfusion between three times intermittent occlusion and once 40 min of occlusion. These findings indicated that repetition of short time occlusion was useful in order to safely prolong total ischemic time in hemihepatic vascular occlusion.
Vascular occlusion
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