Suspected systemic gas embolism associated with lung tissue perforation caused by a previously inserted chest drain in a dog

OBJECTIVE

To report a case of systemic gas embolism associated with removal of a chest drain perforating a lung lobe in a dog undergoing sternotomy under general anesthesia and intermittent positive pressure ventilation.

CASE SUMMARY

An 8-year-old Cocker Spaniel underwent an exploratory thoracotomy via median sternotomy for surgical management of pyothorax that was treated conservatively for 7 days prior to referral following bilateral chest drain placement. The surgical procedure consisted of a subphrenic mediastinectomy and pericardiectomy. During surgery, it became apparent that the right drain was perforating the right middle lung lobe. Sudden desaturation and rapid hemodynamic deterioration occurred after the drain was removed. A systemic gas embolism was suspected on the basis of clinical signs and results of an arterial blood gas analysis, and immediate supportive treatment was started with an adequate response. Once the surgical procedure was completed, a clear "mill wheel" sound was audible on cardiac auscultation and point-of-care cardiac ultrasound confirmed the presence of gas bubbles in the cardiac chambers. The dog recovered from anesthesia and was managed in the intensive care unit where arterial blood gas analyses were nearly normal and the dog made a full recovery.

NEW OR UNIQUE INFORMATION PROVIDED

In people, there are reports of fatal air embolism related to the use of chest drains. To our knowledge, this is the first case report in dogs of a systemic gas embolism during open-chest surgery caused by a chest drain perforating a lung lobe. Immediate recognition and aggressive treatment of this life-threatening condition should be provided in order to achieve a favorable outcome.

Laparoscopic image of carbon dioxide embolism during laparoscopic hepatectomy: a case report

Background

Carbon dioxide embolism is a life-threatening complication of laparoscopic hepatectomy.

Case presentation

A 59-year-old man was admitted for laparoscopic hepatectomy. Approximately 5 h after commencing the operation, we observed a gradual decline in the SpO₂ from 100 to 94%, reduction in the ETCO₂ from 44 to 19 mmHg, reduction in the systolic blood pressure from 100 to 82 mmHg, and elevation of the heart rate from 82 to 120 beats/min. Intraoperatively, the image displayed on the laparoscopic monitor revealed a small tear in the vein. The inspired O₂ fraction was raised to 1.0, intravenous phenylephrine (0.1 mg bolus) was administered, and the respiratory rate was increased. After the patient was stabilized, the injured vein was cut and sealed. After the embolic event, the entire operation was completed without complications.

Conclusions

Careful observation of the laparoscopic monitor is important, particularly during establishment of pneumoperitoneum in patients undergoing laparoscopic hepatectomy.

General anaesthetic considerations for haemostasis in orbital surgery

Orbital surgery is often conducted in areas with limited exposure where vital structures are tightly crowded together. A bloodless field is paramount in orbital surgery for the proper identification of normal and pathologic tissue and even minimal bleeding can obscure the surgical field, making surgery more difficult and increasing the risk of complications. Surgery for highly vascular orbital lesions is an additional situation where maintaining an adequate surgical field is often challenging but paramount. The role of the anaesthetist in controlling surgical blood loss has been increasingly recognized in the last few decades. Various techniques including hypotensive anaesthesia have been described, but the control of intraoperative bleeding does not rely on a single particular technique, but a series of well-designed interventions that result in optimal conditions. An understanding of the anaesthetic considerations pertinent to haemostasis is invaluable for oculoplastic surgeons. Additionally, with the growing use of endonasal approaches to medial wall decompression and accessing the medial orbit, it has become increasingly important that orbital surgeons understand the anaesthetic requirements of their colleagues in other disciplines.