RESUMO
Carbon dioxide (CO) embolism is a complication of laparoscopic surgery that, although often does not have adverse sequelae, can be fatal. This is due to the fact that when CO is injected into the blood vessels, the bubbles impede blood flow, which clinically expresses as: decreased stroke volume, hypoxemia, sudden fall or sudden increase in expired CO, bradycardia, hypotension, dyspnea, cyanosis, arrhythmias, bilateral mydriasis, murmur in a mill wheel at auscultation and cardiovascular collapse with cardiorespiratory arrest. In this article we will present physiology of venous embolism, diagnosis, syntoms, treatment and prevention.
La embolia por dióxido de carbono (CO) es una complicación de la cirugía laparoscópica que, aunque a menudo no presenta secuelas adversas, puede ser fatal. Esto se debe a que al inyectar CO en los vasos sanguíneos las burbujas impiden el flujo de sangre, lo que clínicamente se expresa como: disminución del volumen sistólico, hipoxemia, caída repentina o aumento súbito del CO espirado, bradicardia, hipotensión, disnea, cianosis, arritmias, midriasis bilateral, soplo en rueda de molino a la auscultación y al colapso cardiovascular con paro cardiorrespiratorio. En este trabajo presentaremos fisiología del embolismo venoso, cuadro clínico, diagnóstico, tratamiento y formas de prevenir que ocurra este evento.
Assuntos
Humanos , Dióxido de Carbono/efeitos adversos , Laparoscopia/efeitos adversos , Embolia Aérea/etiologia , Fatores de Risco , Embolia Aérea/diagnóstico , Embolia Aérea/terapiaAssuntos
Biópsia com Agulha de Grande Calibre/efeitos adversos , Embolia Aérea/etiologia , Biópsia Guiada por Imagem/efeitos adversos , Tomografia Computadorizada por Raios X , Embolia Aérea/diagnóstico , Seguimentos , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Imageamento por Ressonância MagnéticaRESUMO
The presence in adults of intrahepatic portal gas is a multifactorial event in which systemic inflammatory and prothrombotic factors coexist, it is common in patients with advanced liver cirrhosis and rare in those with a healthy liver, however its frequency increases with the presence of inflammatory abdominal disorders and hypercoagulability related to systemic inflammatory response, their manifestations are unspecific and varies according to severity. We study two cases with unspecific symptoms, where imaging studies reported intrahepatic portal gas, one secondary to diverticular disease and the second related to liver abscesses, which favorably response with surgical, antibiotic and anticoagulant treatment.
Assuntos
Embolia Aérea/diagnóstico , Hepatopatias/diagnóstico , Veia Porta , Trombose Venosa/diagnóstico , Doença Aguda , Idoso , Feminino , Gases , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
La presencia de gas portal intrahepático en adultos es un fenómeno multifactorial en el que se comparten factores inflamatorios y protrombóticos sistémicos, frecuente en pacientes con cirrosis hepática avanzada y raro en individuos con hígado sano, sin embargo la presencia de focos inflamatorios abdominales y estados de hipercoagulabilidad secundaria a la respuesta inflamatoria sistémica la hace más frecuente, sus manifestaciones son inespecíficas y variables según la gravedad del cuadro. Presentamos dos pacientes con sintomatología inespecífica y estudios imagenológicos que reportaron gas portal intrahepático, uno secundario a enfermedad diverticular y otro a abscesos hepáticos que evolucionaron favorablemente con tratamiento quirúrgico, antibiótico y anticoagulante.
The presence in adults of intrahepatic portal gas is a multifactorial event in which systemic inflammatory and prothrombotic factors coexist, it is common in patients with advanced liver cirrhosis and rare in those with a healthy liver, however its frequency increases with the presence of inflammatory abdominal disorders and hypercoagulability related to systemic inflammatory response, their manifestations are unspecific and varies according to severity. We study two cases with unspecific symptoms, where imaging studies reported intrahepatic portal gas, one secondary to diverticular disease and the second related to liver abscesses, which favorably response with surgical, antibiotic and anticoagulant treatment.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Aérea/diagnóstico , Hepatopatias/diagnóstico , Veia Porta , Trombose Venosa/diagnóstico , Doença Aguda , GasesRESUMO
A embolia gasosa provocada pela utilização do peróxido de hidrogênio é um fenômeno que não é descrito na rotina clínica veterinária, neste sentido descreve-se a ocorrência de embolia gasosa venosa massiva em coelho durante a limpeza e desinfecção de um abscesso no masseter utilizando peróxido de hidrogênio a 3%. Ao injetar peróxido de hidrogênio sobre pressão na cavidade do abscesso, o animal teve uma parada cardiorrespiratória súbita e veio a óbito. A necropsia foram observadas inúmeras bolhas de ar (êmbolos gasosos) na veia cava caudal e tronco pulmonar, atelectasia e enfisema pulmonar. No exame histopatológico observou-se a presença de bolhas de ar em vasos da região adjacente ao abcesso e em artérias pulmonares bem como hemorragia intersticial pulmonar. Os rins, o fígado e o encéfalo apresentavam congestão. O colapso cardiorrespiratório súbito durante a utilização deste produto, associado aos achados de necropsia e histopatológicos sugerem que a embolia gasosa venosa massiva ocorreu devido à utilização do peróxido de hidrogênio. Devido à gravidade do caso apresentado e à possibilidade de ocorrência desta patologia, seu uso deve ser evitado em condições que determinem seu acúmulo em cavidades.
Gas embolism caused by the use of hydrogen peroxide is a phenomenon that is not described in clinical routine, in this sense describes the occurrence of massive venous air embolism in rabbits during cleaning and disinfection of an abscess in the masseter using hydrogen peroxide 3%. By injecting hydrogen peroxide under pressure in the cavity of the abscess, the animal had a sudden cardiac arrest and had died. At necropsy were observed numerous air bubbles (gaseous emboli) in the caudal vena cava and pulmonary artery, pulmonary emphysema and atelectasis. Histopathology observed in the presence of air bubbles in blood vessels in the region adjacent to the pulmonary arteries and abscesses as well as interstitial lung hemorrhage. The kidneys, liver and brain showed congestion. The sudden cardiorespiratory collapse when using this product, associated with the necropsy and histopathological findings suggest that the venous air embolism occurred due to massive use of hydrogen peroxide. Due to the severity of the case presented and the possibility of occurrence of this pathology, its use should be avoided in conditions that determine its accumulation in cavities.
Assuntos
Animais , Embolia Aérea/classificação , Embolia Aérea/diagnóstico , Embolia Aérea/veterináriaRESUMO
A embolia gasosa provocada pela utilização do peróxido de hidrogênio é um fenômeno que não é descrito na rotina clínica veterinária, neste sentido descreve-se a ocorrência de embolia gasosa venosa massiva em coelho durante a limpeza e desinfecção de um abscesso no masseter utilizando peróxido de hidrogênio a 3%. Ao injetar peróxido de hidrogênio sobre pressão na cavidade do abscesso, o animal teve uma parada cardiorrespiratória súbita e veio a óbito. A necropsia foram observadas inúmeras bolhas de ar (êmbolos gasosos) na veia cava caudal e tronco pulmonar, atelectasia e enfisema pulmonar. No exame histopatológico observou-se a presença de bolhas de ar em vasos da região adjacente ao abcesso e em artérias pulmonares bem como hemorragia intersticial pulmonar. Os rins, o fígado e o encéfalo apresentavam congestão. O colapso cardiorrespiratório súbito durante a utilização deste produto, associado aos achados de necropsia e histopatológicos sugerem que a embolia gasosa venosa massiva ocorreu devido à utilização do peróxido de hidrogênio. Devido à gravidade do caso apresentado e à possibilidade de ocorrência desta patologia, seu uso deve ser evitado em condições que determinem seu acúmulo em cavidades.(AU)
Gas embolism caused by the use of hydrogen peroxide is a phenomenon that is not described in clinical routine, in this sense describes the occurrence of massive venous air embolism in rabbits during cleaning and disinfection of an abscess in the masseter using hydrogen peroxide 3%. By injecting hydrogen peroxide under pressure in the cavity of the abscess, the animal had a sudden cardiac arrest and had died. At necropsy were observed numerous air bubbles (gaseous emboli) in the caudal vena cava and pulmonary artery, pulmonary emphysema and atelectasis. Histopathology observed in the presence of air bubbles in blood vessels in the region adjacent to the pulmonary arteries and abscesses as well as interstitial lung hemorrhage. The kidneys, liver and brain showed congestion. The sudden cardiorespiratory collapse when using this product, associated with the necropsy and histopathological findings suggest that the venous air embolism occurred due to massive use of hydrogen peroxide. Due to the severity of the case presented and the possibility of occurrence of this pathology, its use should be avoided in conditions that determine its accumulation in cavities.(AU)
Assuntos
Animais , Embolia Aérea/classificação , Embolia Aérea/diagnóstico , Embolia Aérea/veterináriaRESUMO
Ischemic stroke due to embolic air is uncommon. There are few reports of patients with air embolic stroke as a complication of endoscopic procedures. The temporal relationship between the stroke and this procedure is the most important clue for the diagnosis. CT scan and MRI of the brain are confirmatory tests. The morbidity and mortality is high. Patients should be hospitalized in a critical care service and treated as soon as possible with oxygen in a pressure camera. We report a 52 years old woman with an ovarian cancer that, during an upper gastrointestinal endoscopy, had a severe alteration of consciousness that did not respond to the use of Flumazenil. A CT scan showed multiple areas of air embolism in the watershed area between anterior and middle right cerebral arteries. A conservative treatment was decided and the patients died 48 hours later.
Assuntos
Embolia Aérea/etiologia , Endoscopia Gastrointestinal/efeitos adversos , Infarto da Artéria Cerebral Anterior/etiologia , Infarto da Artéria Cerebral Média/etiologia , Artéria Cerebral Anterior , Embolia Aérea/diagnóstico , Evolução Fatal , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico , Infarto da Artéria Cerebral Média/diagnóstico , Pessoa de Meia-Idade , Artéria Cerebral Média , Tomografia Computadorizada por Raios XRESUMO
Ischemic stroke due to embolic air is uncommon. There are few reports of patients with air embolic stroke as a complication of endoscopic procedures. The temporal relationship between the stroke and this procedure is the most important clue for the diagnosis. CT scan and MRI of the brain are confirmatory tests. The morbidity and mortality is high. Patients should be hospitalized in a critical care service and treated as soon as possible with oxygen in a pressure camera. We report a 52 years old woman with an ovarian cancer that, during an upper gastrointestinal endoscopy, had a severe alteration of consciousness that did not respond to the use of Flumazenil. A CT scan showed multiple areas of air embolism in the watershed area between anterior and middle right cerebral arteries. A conservative treatment was decided and the patients died 48 hours later.