Thumbnail
Access Restriction
Subscribed

Author Schäfer, Simon T. ♦ Lindemann, Jochen ♦ Brendt, Peter ♦ Kaiser, Gernot ♦ Peters, Jürgen
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Lippincott Williams & Wilkins
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Natural sciences & mathematics ♦ Life sciences; biology ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Human anatomy, cytology, histology ♦ Pharmacology and therapeutics ♦ Diseases ♦ Surgery & related medical specialties ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Cardiovascular System ♦ Anatomy ♦ Eukaryota ♦ Organisms ♦ Cardiovascular Diseases ♦ Animal Diseases ♦ Diseases ♦ Diagnosis ♦ Therapeutics ♦ Surgical Procedures, Operative ♦ Investigative Techniques ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment
Subject Keyword Discipline Anesthesiology ♦ Catheterization, Central Venous ♦ Echocardiography, Doppler ♦ Echocardiography, Transesophageal ♦ Echocardiography ♦ Methods ♦ Embolism, Air ♦ Suction ♦ Ultrasonography, Interventional ♦ Veins ♦ Animals ♦ Cardiac Catheterization ♦ Disease Models, Animal ♦ Therapy ♦ Feasibility Studies ♦ Male ♦ Predictive Value Of Tests ♦ Sensitivity And Specificity ♦ Swine ♦ Comparative Study ♦ Evaluation Studies ♦ Journal Article ♦ Research Support, Non-u.s. Gov't
Abstract BACKGROUND: Venous air embolism (VAE) is a potentially fatal complication during surgical procedures with patients in the sitting position. Since methods for detection of persistent low-volume VAE and targeted air aspiration are limited, we tested the hypotheses that transvenous intracardiac echocardiography (ICE) 1) improves detection of small air emboli in comparison to transesophageal echocardiography (TEE) and precordial Doppler monitoring (PCD) techniques, and that 2) image-guided multiorifice central venous catheter manipulation improves air recovery in moderate and large VAE, when compared with aspiration with the multiorifice central venous catheter in a static position. METHODS AND RESULTS: Adult swine (73 +/- 4.6 kg, n = 7) were premedicated, anesthetized with propofol and fentanyl, endotracheally intubated, mechanically ventilated, and placed in a 45 degrees head-up position. First, nine different small volumes of air emboli (0.05-1 mL) were randomly injected via an ear vein, and VAE detection methods were applied in random order. For 378 small volume air injections, ICE had a much higher sensitivity (82.5%, P < 0.0001) on the analysis of VAE detection than TEE (52.8%) or PCD (46.8%), with no difference (P = 0.571) between TEE and PCD. An injected air volume as small as 0.15 mL was detected by ICE in 90% of injections performed, whereas PCD and TEE detected only half of the boluses of 0.25-0.30 mL of air, and required boluses of 0.4-1.0 mL to achieve 100% detection. Air recovery was assessed in a second series of moderate VAE (2, 5, 10 mL); image-guided aspiration-catheter manipulation recovered significantly more (34.1% vs 17.2%, P < 0.0001) intracardiac air than without catheter manipulation. In a third series of injections of large air volumes (25, 50, and 100 mL), air recovery was not significantly different with ultrasound-guided aspiration (41.3% vs 31.8%, P = 0.11). CONCLUSION: Small air emboli are detected by ICE with much greater sensitivity compared with both PCD and TEE techniques. Furthermore, recovery of embolized air is enhanced by image-guided manipulation of a multiorifice central venous catheter. Clinical studies are required to assess this technique during surgery with patients in the sitting position.
Description Country affiliation: Germany
Author Affiliation: Schäfer ST ( Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum Essen, Essen, Deutschland, Germany. simon.schaefer@uni-due.de)
ISSN 00032999
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2008-01-01
Publisher Place United States
e-ISSN 15267598
Journal Anesthesia & Analgesia
Volume Number 106
Issue Number 1


Source: WHO-Global Index Medicus