Anaesthetic Emergencies

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Anaesthetic Emergencies

• Air EmbolismDr T E Allan Palmer FRCA FANZCA
  MDallan_at_palmer.net.au

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Aetiology - Passive

• Open venous sinuses
• Neurosurgical cases in sitting position
• Spinal surgery eg laminectomy
• Central venous catheters

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Aetiology - Active

• Rapid blood transfusion under pressure
• Laparoscopy (carbon dioxide)
• Femoral canal reaming and cement
• Gas cooled lasers

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Presentation

• Sudden fall in end tidal carbon dioxide
• Low cardiac output
• Hypoxia
• bradycardia

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Diagnosis

• Capnography
• Doppler
• Oesophageal stethoscope
• Mill Wheel murmur
• Fall in oxygen saturation

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Prevention

• Care with fluid infusors
• Remove all air from infusion bags
• Level one type infusors
• Air filter
• Air detector
• Care with positioning
• Maintain site of surgery below level of heart
  where possible

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Prevention

• Care with central venous lines
• Closed systems eg pressure transducers
• Minimum number of connections
• Change connections below heart level
• Remove lines with patient head down in expiration
• If blood doesnt come out air will go in!

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Treatment

• 100 oxygen
• Stop doing whatever caused it
• Surgeon, equipment, position
• Flood air entry point with saline
• Remove air if CVC in situ
• Be ready with CPR to break up airlock.

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Questions

• Air embolism has no symptoms in the awake
  patient?
• Air is rapidly absorbed from the circulation?
• Air embolism can cause a stroke (CVA) ?