Anesth Analg 2008; 107:1085-
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31818259e8
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Editor's note: Due to a publisher's error, the following response by Amar et al. to the Letter to the Editor by Lohser and Brodsky published in the July 2008 issue (Anesth Analg 2008;107:342) was left out of the July issue. The publisher apologizes for the error.
Air Penetration into the Tissues During Oral Surgery
Giuseppina Magni, MD, PhD,
Carmela Imperiale, MD,
Giovanni Rosa, MD, and
Roberto Favaro, MD
Department of Anaesthesia and Intensive Care Policlinico Umberto I; Viale del Policlinico 155—00100, Rome, Italy; gmagni{at}yahoo.com
In Response:
We agree with Rehman et al.1 regarding the importance of recognizing the instrumentation used during dental surgery and the possible associated life-threatening complications. Moreover, as Dr. Rehman correctly states, our patient's lungs were ventilated with an oxygen-nitrous oxide mixture rather than an air-nitrous oxide mixture, as erroneously reported in the case description.2
We also agree that once pressurized air has penetrated the tissues, the onset of adverse signs is usually rapid, starting with progressive swelling over the upper chest, neck, and chin and crepitus on the neck and face.3 Several cases of major, life-threatening, and fatal complication due to pulmonary embolism have been reported.4 As described by Rehman et al., our case is unusual since the patient's neurological symptoms started 45 min after restoration of consciousness and no signs or symptoms of pulmonary embolism were detected before systemic cerebral symptoms occurred. However, when the patient's condition deteriorated, moderate anterior neck crepitus and swelling was noted. This sign was, in all probability, evident before the clinical deterioration occurred, but was not immediately noted, because it was modest in size and the patient was clinically stable and not reporting any discomfort. Because this is the first such case reported in the literature, we don't really know how much time is necessary before clinical signs of cerebral air embolism should be evident.
REFERENCES
- Rehman KU, Monaghan A, Tong JL. Air penetration into the tissues during oral surgery. Anesth Analg 2008;107:1085[Free Full Text]
- Magni G, Imperiale C, Rosa G, Favaro R. Nonfatal cerebral air embolism after dental surgery. Anesth Analg 2008;106: 249–51[Abstract/Free Full Text]
- Chen SC, Lin FY, Chang KJ. Subcutaneous emphysema and pneumomediastinum after dental extraction. Am J Emerg Med 1999;17:678–80[Web of Science][Medline]
- Davies JM, Campbell LA. Fatal air embolism during dental implant surgery: a report of three cases. Can J Anaesth 1990;37:112–21[Web of Science][Medline]
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