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Anaesthetic Emergencies

Anaesthetic Emergencies. Air Embolism Dr T E Allan Palmer FRCA FANZCA MD allan@palmer.net.au. Aetiology - Passive. Open venous sinuses Neurosurgical cases in sitting position Spinal surgery eg laminectomy Central venous catheters. Aetiology - Active. Rapid blood transfusion under pressure

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Anaesthetic Emergencies

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  1. Anaesthetic Emergencies Air EmbolismDr T E Allan Palmer FRCA FANZCA MDallan@palmer.net.au

  2. Aetiology - Passive • Open venous sinuses • Neurosurgical cases in sitting position • Spinal surgery eg laminectomy • Central venous catheters

  3. Aetiology - Active • Rapid blood transfusion under pressure • Laparoscopy (carbon dioxide) • Femoral canal reaming and cement • Gas cooled lasers

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

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

  6. 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

  7. 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 doesn’t come out air will go in!

  8. 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.

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

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