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LETTER TO THE EDITOR

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

Department of Anesthesiology & Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea (Koo) koobn{at}yumc.yonsei.ac.kr, Department of Anesthesiology and Pain Medicine, Gachon Medical School, Gil Medical Center, Incheon, Korea (Kim) Department of Anesthesiology & Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea (Kil, Hong)

In Response:

I would like to thank Adachi et al. (1) for discussing their experiences with the Cavitron Ultrasonic Surgical Aspirator®.

Fortunately, we have not had a case in our hospital of severe venous air embolism (VAE) related to the CUSA® similar to those described by Adachi et al. However, as described in our article (2), VAE almost always occurs during the use of CUSA®, and in case of severe hepatic disease, paradoxical embolism also may occur. The cases described by Adachi et al. show that catastrophic VAE is entirely possible with the use of CUSA®.

As we described, it is inconvenient to use transesophageal echocardiography as a routine monitor. However, when clinical findings suggest severe VAE, one should immediately use transesophageal echocardiography to detect the location of the embolism and guide therapy.

References

1. Adachi YU, Doi M, Sato S. Cardiac arrest by venous air embolism during hepatic resection using the Cavitron Ultrasonic Surgical Aspirator®. Anesth Analg 2006;103:493–4.[Free Full Text]
2. 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]

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