HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas Yeh, Jr Erle H. Austin, III Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yeh, T. Articles by Edmonds, H. L. Search for Related Content PubMed PubMed Citation Articles by Yeh, T., Jr Articles by Edmonds, H. L., Jr Related Collections Anesthesia Cerebral protection

J Thorac Cardiovasc Surg 2003;126:589-591
© 2003 The American Association for Thoracic Surgery

Brief communication

Rapid recognition and treatment of cerebral air embolism: the role of neuromonitoring

^a Department of Surgery, Division of Cardiothoracic Surgery, University of Louisville, Louisville, Ky, USA
^b Department of Anesthesiology, University of Louisville, Louisville, Ky, USA

Received for publication October 8, 2002; accepted for publication December 2, 2002.

^* Address for reprints: Harvey L. Edmonds, Jr, PhD, Department of Anesthesiology, University of Louisville, 530 South Jackson, Suite C2A03, Louisville, KY 40202-3617, USA
LHARVO@louisville.edu

The first 20% of the full text of this article appears below.

Dr Harvey l. Edmonds

Cerebral air embolism is a rare but serious complication of cardiac operations.¹ Transcranial Doppler ultrasonography is a sensitive monitor of gas bubble entry into the cerebral circulation. Here we describe a case of cerebral air embolism during a Fontan procedure and the role of transcranial Doppler ultrasonography, cerebral oximetry, and electroencephalography (EEG) in its recognition and management.

Clinical summary

A 27-month-old boy with an unbalanced atrioventricular canal (hypoplastic left ventricle and dominant right ventricle) and hypoplastic aortic arch underwent the Norwood procedure at 5 days of age. The preoperative Fontan evaluation revealed trivial common atrioventricular valve regurgitation, good ventricular function, low pulmonary artery pressures, no pulmonary artery stenoses, and a left superior vena cava that was closed before the Fontan procedure.

Routine intraoperative monitoring included transesophageal echocardiography, femoral arterial and central venous pressure, electrocardiography, pulse oximetry, 8-channel EEG, right middle cerebral artery transcranial Doppler ultrasonography, and bihemispheric transcranial cerebral oximetry (spatially resolved, dual-wavelength, near-infrared reflectance spectroscopy).

After aortic cannulation, cardiopulmonary bypass was initiated. With the heart beating, an extracardiac nonfenestrated Fontan connection was constructed with pedicled pericardium.² After weaning from cardiopulmonary bypass, increased central venous pressure (22 mm Hg with a left atrial pressure of 5 mm Hg) and low systemic blood pressure and oxygen saturation prompted resumption . . . [Full Text of this Article]

This article has been cited by other articles:

				J. B. Clark, M. L. Barnes, A. Undar, and J. L. Myers Multimodality Neuromonitoring for Pediatric Cardiac Surgery: Our Approach and a Critical Appraisal of the Available Evidence World Journal for Pediatric and Congenital Heart Surgery, January 1, 2012; 3(1): 87 - 95. [Abstract] [Full Text] [PDF]

				J. K. Gunn, J. Beca, D. J. Penny, S. B. Horton, Y. A. d'Udekem, C. P. Brizard, K. Finucane, M. Olischar, R. W. Hunt, and L. S. Shekerdemian Amplitude-Integrated Electroencephalography and Brain Injury in Infants Undergoing Norwood-Type Operations Ann. Thorac. Surg., January 1, 2012; 93(1): 170 - 176. [Abstract] [Full Text] [PDF]

				G. W. Fischer and M. E. Stone Cerebral Air Embolism Recognized by Cerebral Oximetry Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2009; 13(1): 56 - 59. [Abstract] [PDF]

				G. W. Fischer Recent Advances in Application of Cerebral Oximetry in Adult Cardiovascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 60 - 69. [Abstract] [PDF]

				M. N. Kavarana, S. Pagni, M. R. Recto, W. L. Sobczyk, T. Yeh Jr, M. Mitchell, and E. H. Austin III Seven-Year Clinical Experience With the Extracardiac Pedicled Pericardial Fontan Operation Ann. Thorac. Surg., July 1, 2005; 80(1): 37 - 43. [Abstract] [Full Text] [PDF]

				D. D. Doblar Intraoperative Transcranial Ultrasonic Monitoring for Cardiac and Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2004; 8(2): 127 - 145. [Abstract] [PDF]