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Mardanpour MM, Sudalaiyadum Perumal A, Mahmoodi Z, Baassiri K, Montiel-Rubies G, LeDez KM, Nicolau DV. Investigation of air bubble behaviour after gas embolism events induced in a microfluidic network mimicking microvasculature. LAB ON A CHIP 2024; 24:2518-2536. [PMID: 38623600 DOI: 10.1039/d4lc00087k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Gas embolism is a medical condition that occurs when gas bubbles are present in veins or arteries, decreasing blood flow and potentially reducing oxygen delivery to vital organs, such as the brain. Although usually reported as rare, gas embolism can lead to severe neurological damage or death. However, presently, only limited understanding exists regarding the microscale processes leading to the formation, persistence, movement, and resolution of gas emboli, as modulated by microvasculature geometrical features and blood properties. Because gas embolism is initially a physico-chemical-only process, with biological responses starting later, the opportunity exists to fully study the genesis and evolution of gas emboli using in vitro microfluidic networks mimicking small regions of microvasculature. The microfluidics networks used in this study, which aim to mimic microvasculature geometry, comprise linear channels with T-, or Y-junction air inlets, with 20, 40, and 60 μm widths (arterial or venous), and a 30 μm width honeycombed network (arterial) with three bifurcation angles (30°, 60°, and 90°). Synthetic blood, equivalent to 46% haematocrit concentrations, and water were used to study the modulation of gas embolism-like events by liquid viscosity. Our study shows that (i) longer bubbles with lower velocity occur in narrower channels, e.g., with 20 μm width; (ii) the resistance of air bubbles to the flow increases with the higher haematocrit concentration; and lastly (iii) the propensity of gas embolism-like events in honeycomb architectures increases for more acute, e.g., 30°, bifurcation angles. A dimensionless analysis using Euler, Weber, and capillary numbers demarcated the conditions conducive to gas embolism. This work suggests that in vitro experimentation using microfluidic devices with microvascular tissue-like structures could assist medical guidelines and management in preventing and mitigating the effects of gas embolism.
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Affiliation(s)
- Mohammad Mahdi Mardanpour
- Department of Bioengineering, Faculty of Engineering, McGill University, Montreal, Québec, H3A 0E9, Canada.
| | | | - Zahra Mahmoodi
- Department of Bioengineering, Faculty of Engineering, McGill University, Montreal, Québec, H3A 0E9, Canada.
| | - Karine Baassiri
- Department of Bioengineering, Faculty of Engineering, McGill University, Montreal, Québec, H3A 0E9, Canada.
| | - Gala Montiel-Rubies
- Department of Bioengineering, Faculty of Engineering, McGill University, Montreal, Québec, H3A 0E9, Canada.
| | - Kenneth M LeDez
- Faculty of Medicine, Health Sciences Centre, Memorial University, St. John's, Newfoundland and Labrador, A1C 5S7, Canada
| | - Dan V Nicolau
- Department of Bioengineering, Faculty of Engineering, McGill University, Montreal, Québec, H3A 0E9, Canada.
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Deng X, Zhou J, Diao M, Li H, Lin X. Effects of different fractions of inspired oxygen on gas embolization during hysteroscopic surgery: A double-blind, randomized, controlled trial. Int J Gynaecol Obstet 2024; 164:1101-1107. [PMID: 37789807 DOI: 10.1002/ijgo.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Gas embolism is a common complication of hysteroscopic surgery that causes serious concern among gynecologists and anesthesiologists due to the potential risk to patients. The factors influencing gas embolism in hysteroscopic surgery have been extensively studied. However, the effect of the oxygen concentration inhaled by patients on gas embolism during hysteroscopic surgery remains elusive. Therefore, we designed a double-blind, randomized, controlled trial to determine whether different inhaled oxygen concentrations influence the occurrence of gas embolism during hysteroscopic surgery. METHODS This trial enrolled 162 adult patients undergoing elective hysteroscopic surgery who were randomly divided into three groups with inspired oxygen fractions of 30%, 50%, and 100%. Transthoracic echocardiography (four-chamber view) was used to evaluate whether gas embolism occurred. Before the start of surgery, the four-chamber view was continuously monitored. RESULTS The number of gas embolisms in the 30%, 50%, and 100% groups was 36 (69.2%), 30 (55.6%), and 24 (44.4%), respectively. The incidence of gas embolism gradually decreased with increasing inhaled oxygen concentration (P = 0.031). CONCLUSION In hysteroscopic surgery, a higher oxygen concentration inhaled by patients may reduce the incidence of gas embolism, indicating that a higher inhaled oxygen concentration, especially 100%, could be recommended for patients during hysteroscopic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=53779, Registration number: ChiCTR2000033202).
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Affiliation(s)
- Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Jieshu Zhou
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Min Diao
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Hao Li
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Xuemei Lin
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
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Xu R, Zhou X, Wang L, Cao Y. Gas embolism during surgical hysteroscopy leading to cardiac arrest and refractory hypokalemia: A case report and review of literature. Medicine (Baltimore) 2023; 102:e35227. [PMID: 37713863 PMCID: PMC10508465 DOI: 10.1097/md.0000000000035227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023] Open
Abstract
RATIONALE One of the catastrophic complications of surgical hysteroscopy is venous gas embolism (VGE), and this event could cause morbidity and in serious cases may even lead to death. However, in cases of VGE accompanied by refractory hypokalemia is rare and can significantly increase the difficulty of treatment and resuscitation. Here, we successfully treated a patient with fatal VGE during surgical hysteroscopy, accompanied by difficult resuscitation with refractory hypokalemia. PATIENT CONCERNS We report a rare case of sudden cardiac arrest due to VGE during surgical hysteroscopy, followed by difficult resuscitation with refractory hypokalemia. DIAGNOSIS VGE was diagnosed by a sudden decrease in EtCO2, a loud mill wheel murmur in the thoracic area, and a small number of air bubbles evacuated from the internal jugular catheter. And refractory hypokalemia was diagnosed by serum potassium levels dropping frequently to as low as 2.0 mmol/L within 36 hours of resuscitation after cardiac arrest. INTERVENTIONS Our vigilant anesthesiologist noticed the early sign of VGE with a sudden drop in EtCO2, and as the cardiac arrest occurred, interventional maneuvers were implemented quickly including termination of the surgical procedure, adjustment of the patient's position, cardiac resuscitation, continuous chest compression, and correction of electrolyte disturbances, particularly refractory hypokalemia during the early stage of resuscitation. OUTCOMES The patient regained consciousness 4 days after the cardiac arrest and was discharged 1 month later without any neurological deficits. LESSONS As a relatively simple procedure, surgical hysteroscopy may have catastrophic complications. This case demonstrates the full course of fatal gas embolism and difficult resuscitation during hysteroscopic surgery, and emphasizes the importance of early detection, prompt intervention, and timely correction of electrolyte disturbances, such as refractory hypokalemia.
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Affiliation(s)
- Rong Xu
- Health Science Center, Ningbo University, Ningbo, China
| | - Xuefei Zhou
- Department of Anesthesiology, Beilun District People’s Hospital of Ningbo, Ningbo, China
| | - Longfei Wang
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Yunfei Cao
- Department of Anesthesiology, Beilun District People’s Hospital of Ningbo, Ningbo, China
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Baassiri K, Nicolau DV. Investigating the Mechanism of Intravascular Bubble Formation in Designed Arrays of Vascularized Systems on a Chip. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083489 DOI: 10.1109/embc40787.2023.10340569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Vascular gas embolism is a rare medical condition, resulting from the existence of air or gas in the venous or arterial system. Gas embolism is associated with a wide range of circulatory, cardiovascular, and neurological complications that can lead to sudden and unexplained death. Despite the recent increase in related studies, gas embolism remains under-reported with a poor understanding of its genesis and pathophysiology. In this work, intravascular bubble formation is investigated in an array of biomimetic microscale systems, where the endogenous generation of gas bubbles is induced by variations in the surrounding pressure. Microfluidic devices, based on polydimethylsiloxane, are designed and fabricated as vascularized systems on a chip with one main channel at two different diameters (30 µm, and 40 µm), surrounded by a pressure chamber (200 µm) on each side, at a separation of 50 µm. Two blood-equivalent solutions, at 20% and 46% hematocrit concentrations were prepared from a glycerin and xanthan gum mixture to mimic the physicochemical characteristics of the blood. As the volume of injected air increased, the events related to gas embolism were occurring at shorter timespans with more significant characteristics, i.e., length and number of bubbles. Additionally, correlations were established between the input parameters, i.e., the vascular diameter and equivalent hematocrit concentration, and the output parameters, i.e., the bubble size, velocity, frequency, and nucleation sites.Clinical Relevance- The reported results constitute a reproducible observation and quantification of intravascular bubble formation induced by global pressure variations, where the emergence of bubbles exhibits different patterns depending on biological characteristics related to gender and medical history.
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Han K, Huang MQ, Deng X, Shang YC. Remaining Vigilant to Paradoxical Air Embolism in Patients Undergoing Hysteroscopic Surgery: A Case Report and Review of the Literature. J Perianesth Nurs 2021; 36:606-611. [PMID: 34740530 DOI: 10.1016/j.jopan.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this case study and review was to understand the perianesthestic care of paradoxical air embolism (PAE) in patients undergoing hysteroscopic surgery. The perianesthestic management record of a patient undergoing hysteroscopic surgery was analyzed to study the characteristics of PAE, and the literature describing the perianesthestic care for PAE was reviewed. The first symptom of PAE in hysteroscopic surgery is often a decrease in end-tidal carbon dioxide (ETCO2), and the complications include embolism of the pulmonary artery, coronary artery, and cerebral artery. The best monitoring method is continuous ETCO2 monitoring, and intraoperative echocardiography is an excellent method to diagnose and guide the treatment of PAE. PAE is a rare but serious complication of hysteroscopic surgery that is associated with organ ischemia and hypoxia. Prevention and treatment of PAE requires the vigilance and cooperation of not only perianesthesia nurses and anesthesiologists but also the surgeons and operating room nurses. Early prevention, proper monitoring, and effective treatment are the keys to successful rescue for PAE.
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Affiliation(s)
- Kun Han
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Man-Qiu Huang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yu-Chao Shang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Elahmedawy H, Snook NJ. Complications of operative hysteroscopy: an anaesthetist's perspective. BJA Educ 2021; 21:240-242. [PMID: 34178379 DOI: 10.1016/j.bjae.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - N J Snook
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Ratner RT, Tsaltas J, Vollenhoven B. Hysteroscopy and the risk of gas embolism: A review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519872407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hysteroscopy is one of the most frequent procedures that a gynecologist will perform over their career. It is also one of the safest procedures. Operative hysteroscopy has an increased risk profile due to the nature of the surgery. The following review will address the issue of gas embolism in hysteroscopy. This review will look at the evidence regarding the likely causation, rates, and potential methods of minimizing risk to patients as well as treatment options available should this complication arise.
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Affiliation(s)
- Roni T Ratner
- Gynaecological Endoscopy and Endometriosis Surgery, Monash Health and Monash University, Bentleigh East, VIC, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery, Monash Health and Monash University, Bentleigh East, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Beverley Vollenhoven
- Women’s and Newborn Programme, Monash Health, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Monash IVF Group, Melbourne, VIC, Australia
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Vilos GA, Hutson JR, Singh IS, Giannakopoulos F, Rafea BA, Vilos AG. Venous Gas Embolism during Hysteroscopic Endometrial Ablation: Report of 5 Cases and Review of the Literature. J Minim Invasive Gynecol 2020; 27:748-754. [DOI: 10.1016/j.jmig.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
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Hong B, Lee KH, Yoo HJ, Lee J, Yun S, Ahn KT, Chung W. Unexpected development of intraoperative paradoxical air embolism during hysteroscopic myomectomy. J OBSTET GYNAECOL 2019; 40:885-886. [DOI: 10.1080/01443615.2019.1636777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Boohwi Hong
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Ki Hwan Lee
- Department of Obstetrics and Gynaecology, Chungnam National University Hospital, Daejeon, South Korea
- Department of Obstetrics and Gynaecology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Heon Jong Yoo
- Department of Obstetrics and Gynaecology, Chungnam National University Hospital, Daejeon, South Korea
- Department of Obstetrics and Gynaecology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jieun Lee
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sangwon Yun
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kye Taek Ahn
- Department of Internal Medicine, Division of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Woosuk Chung
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Chungnam National University, Daejeon, South Korea
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