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LETTER TO THE EDITOR

Cardiac Arrest by Venous Air Embolism During Hepatic Resection Using the Cavitron Ultrasonic Surgical Aspirator®

Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu City, Japan, yuadachi{at}poppy.ocn.ne.jp

To the Editor:

Koo et al. (1) recently demonstrated that patients undergoing resection of the liver using the Cavitron Ultrasonic Aspirator (CUSA®) have venous air embolism (VAE), a potentially fatal complication. The incidence of VAE using CUSA® had not been investigated.

Within 6 mo of introducing the CUSA® device in our University Hospital, we had 3 cases of cardiac arrest during hepatic resection (2). The patients showed a sudden decrease of arterial blood pressure (systolic blood pressure <40 mm Hg) and end-tidal carbon dioxide (less than 20 mm Hg) at the middle phase of resection. In two cases we could aspirate a small amount of air from the pulmonary catheter fortuitously placed at the beginning of anesthesia. All patients were resuscitated by rapid intravascular administration, IV administration of catecholamines, and trans-diaphragmatic cardiac massage. The surgeon reported palpating a completely collapsed heart immediately after the cardiac arrest. These episodes were diagnosed as VAE, and CUSA®-related air entrainment from liver was strongly suspected.

Koo et al. (1) reported that there was no direct correlation observed between the VAE and cardiorespiratory events, as severe VAE were rare. After encountering our first two cases (2), we now aggressively minimize the duration of using the CUSA® device. Moreover, we place a central venous catheter in every patient, as recommended by Koo et al. (1). Using these interventions, we have had no mortalities from VAE with the CUSA®. Although transesophageal echocardiography (TEE) is the most sensitive method for the detection of VAE, the routine monitoring by TEE is not practical in most of our operating rooms. Our experience is consistent with the recommendations by Koo et al. (1), and we believe their guidelines are required to ensure safety.

References

1. Koo BN, Kil HK, Choi JS, et al. Hepatic resection by the Cavitron Ultrasonic Surgical Aspirator® increases the incidence and severity of venous air embolism. Anesth Analg 2005;101:966–70.[Abstract/Free Full Text]
2. Adachi Y, Taoda M, Uchihashi T, Sato T. Two cases of venous air embolism during hepatic resection using a CUSA [in Japanese]. Sosei 1996;14:123–6.

This article has been cited by other articles:

				B.-N Koo, J. Y. Kim, H. K. Kil, and Y. W. Hong Cardiac Arrest by Venous Air Embolism During Hepatic Resection Using the Cavitron Ultrasonic Surgical Aspirator(R) Anesth. Analg., August 1, 2006; 103(2): 494 - 494. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Adachi, Y. U. Articles by Sato, S. Search for Related Content PubMed PubMed Citation Articles by Adachi, Y. U. Articles by Sato, S.