P1: SBT
0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18
84 Air Embolus■Carbon dioxide embolus from laparoscopic insufflation
■Can occur with right to left shunt (VSD, etc.)
■Source of air usually massiveSigns & Symptoms
■Cardiovascular collapse
■Failure to respond to usual resuscitationtests
Specific Tests
■EKG may show ischemic changes with coronary air embolus
■If intraoperative TEE is in use, intracardiac air will be seendifferential diagnosis
■Pulmonary embolism
➣Usually in ward patient with DVT
➣Rarely occurs intraoperatively
■Stroke
➣Intraoperative embolic stroke rarely causes cardiovascular col-
lapse
■Myocardial Infarction
➣Severe ischemia seen on EKG
■Traumatic cardiac tamponade
➣Echocardiogram or surgical exploration
■Tension pneumothorax
➣Hyperresonant breath sounds
➣Diagnose+treat with needle thoracostomymanagement
What to Do First
■Position patient head down, left side down
➣Keeps air in apex of right ventricle where slow reabsorption
occurs
■Cardiorespiratory support
➣Intubation+mechanical ventilation
➣100% FiO2 to help reabsorption (creates nitrogen gradient)
➣Volume+pressors as needed
■Find and correct source of air embolism
➣Close hole in vein
➣Flush all lines
➣Check bypass machine and connections