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craniectomy
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Articles
Joseph D. Tobias, M.D., Joel O. Johnson, M.D., Ph.D., David F. Jimenez, M.D., Constance M. Barone, M.D., D. Scott McBride, B.A.
Journal:
Anesthesiology
Anesthesiology. August 2001; 95(2):340–342
Published: August 2001
Abstract
Background Various studies have reported an incidence of venous air embolism (VAE) as high as 82.6% during surgical procedures for craniosynostosis. There has been an increase in the use of minimally invasive, endoseopie surgical procedures, including applications for endoscopic strip craniectomy. The current study prospectively evaluated the incidence of VAF during endoscopic strip craniectomy. Methods Continuous, intraoperative monitoring for VAE was performed using precordial Doppler monitoring. A recording was made of the Doppler tones and later reviewed to verify its accuracy. Results The cohort for the study included 50 consecutive neonates and infants ranging in age from 3.5 to 36 weeks and ranging in weight from 3 to 9 kg. Surgical time varied from 31 to 95 min for a total of 2,701 mm of operating time, during which precordial Doppler tones were auscultated. In 46 patients, there was no evidence of VAE. In four patients, there was a single episode of VAE. Two of the episodes of VAE were grade I (change in Doppler tones), and two were grade H (change in Doppler tones and decrease in end-tidal carbon dioxide). No grade III (decrease in systolic blood pressure by 20% from baseline) VAF was noted. Conclusion In addition to previously reported benefits of decreased blood loss, decreased surgical time, and improved postoperative recovery time, the authors noted a low incidence of VAF during endoscopic strip craniectomy in neonates and infants.
Articles
Journal:
Anesthesiology
Anesthesiology. January 2000; 92(1):20
Published: January 2000
Abstract
Background Investigations to determine the incidence of venous air embolism in children undergoing craniectomy for craniosynostosis repair have been limited, although venous air embolism has been suspected as the cause of hemodynamic instability and sometimes death. A precordial Doppler ultrasonic probe is an accepted method for detection of venous air embolism and is readily available at most institutions. Methods A prospective study was conducted using a precordial Doppler ultrasonic probe in children undergoing craniectomy for craniosynostosis repair. The Doppler signal was continuously monitored intraoperatively for characteristic changes of venous air embolism. A recording was made of the precordial Doppler probe pulses, which was later reviewed by a neuroanesthesiologist, blinded to the intraoperative events. This information was correlated with the intraoperative events and episodes of venous air embolism were graded. Results Twenty-three patients were enrolled in the study during the 2-yr study period. Nineteen patients (82.6%) demonstrated 64 episodes of venous air embolism; six patients (31.6%) had hypotension associated with venous air embolism. Thirty-two episodes of hypotension were demonstrated in eight patients (34.7%). None of the patients developed cardiovascular collapse. Conclusion The incidence of venous air embolism in our study of 23 children undergoing craniectomy for craniosynostosis was 82.6%. Though most episodes of venous air embolism during craniosynostosis repair are without hemodynamic consequences, the preemptive placement of a precordial Doppler ultrasonic probe is a noninvasive, economic, and safe method for the detection of venous air embolism. Prompt recognition may allow for the early initiation of therapy, thereby decreasing morbidity and mortality rates related to venous air embolism.
Articles
Articles
MARK M. HARRIS, M.D., TERRY A. YEMEN, M.D., ALEX DAVIDSON, M.D., MAUREEN A. STRAFFORD, M.D., RICHARD W. ROWE, M.D., STEPHEN P. SANDERS, M.D., MARK A. ROCKOFF, M.D.
Journal:
Anesthesiology
Anesthesiology. November 1987; 67(5):816–818
Published: November 1987
Articles
MARK M. HARRIS, M.D., MAUREEN A. STRAFFORD, M.D., RICHARD W. ROWE, M.D., STEPHEN P. SANDERS, M.D., KEN R. WINSTON, M.D., MARK A. ROCKOFF, M.D.
Journal:
Anesthesiology
Anesthesiology. November 1986; 65(5):547–549
Published: November 1986
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