Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen

To describe a clinical scenario consistent with the diagnosis of cerebral arterial gas embolism (CAGE) acquired during an outpatient bronchoscopy. Our discussion explores the mechanisms and diagnosis of CAGE and the role of hyperbaric oxygen therapy. A diagnostic bronchoscopy was performed on a 70-y...

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Veröffentlicht in:Canadian journal of anesthesia 2002, Vol.49 (1), p.96-99
Hauptverfasser: WHERRETT, Chris G, MEHRAN, Reza J, BEAULIEU, Marc-Andre
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creator WHERRETT, Chris G
MEHRAN, Reza J
BEAULIEU, Marc-Andre
description To describe a clinical scenario consistent with the diagnosis of cerebral arterial gas embolism (CAGE) acquired during an outpatient bronchoscopy. Our discussion explores the mechanisms and diagnosis of CAGE and the role of hyperbaric oxygen therapy. A diagnostic bronchoscopy was performed on a 70-yr-old man who had had a lobectomy for bronchogenic carcinoma three months earlier. During the direct insufflation of oxygen into the right middle lobe bronchus, the patient became unresponsive and developed subcutaneous emphysema. Immediately, an endotracheal tube and bilateral chest tubes were placed with resultant improvement in his oxygen saturation. However, he remained unresponsive with extensor and flexor responses to pain. Later, in the intensive care unit, he exhibited seizure activity requiring anticonvulsant therapy. Sedation was utilized only briefly to facilitate controlled ventilation. Investigations revealed a negative computerized tomography (CT) scan of the head, a normal cerebral spinal fluid examination, a CT chest that showed evidence of barotrauma, and an abnormal electroencephalogram. Fifty-two hours after the event, he was treated for presumed CAGE with hyperbaric oxygen using a modified United States Navy Table 6. Twelve hours later he had regained consciousness and was extubated. He underwent two more hyperbaric treatments and was discharged from hospital one week after the event, fully recovered. A patient with presumed CAGE made a complete recovery following treatment with hyperbaric oxygen therapy even though it was initiated after a significant time delay.
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Our discussion explores the mechanisms and diagnosis of CAGE and the role of hyperbaric oxygen therapy. A diagnostic bronchoscopy was performed on a 70-yr-old man who had had a lobectomy for bronchogenic carcinoma three months earlier. During the direct insufflation of oxygen into the right middle lobe bronchus, the patient became unresponsive and developed subcutaneous emphysema. Immediately, an endotracheal tube and bilateral chest tubes were placed with resultant improvement in his oxygen saturation. However, he remained unresponsive with extensor and flexor responses to pain. Later, in the intensive care unit, he exhibited seizure activity requiring anticonvulsant therapy. Sedation was utilized only briefly to facilitate controlled ventilation. Investigations revealed a negative computerized tomography (CT) scan of the head, a normal cerebral spinal fluid examination, a CT chest that showed evidence of barotrauma, and an abnormal electroencephalogram. Fifty-two hours after the event, he was treated for presumed CAGE with hyperbaric oxygen using a modified United States Navy Table 6. Twelve hours later he had regained consciousness and was extubated. He underwent two more hyperbaric treatments and was discharged from hospital one week after the event, fully recovered. A patient with presumed CAGE made a complete recovery following treatment with hyperbaric oxygen therapy even though it was initiated after a significant time delay.</description><identifier>ISSN: 0832-610X</identifier><identifier>EISSN: 1496-8975</identifier><identifier>DOI: 10.1007/BF03020427</identifier><identifier>PMID: 11782337</identifier><identifier>CODEN: CJOAEP</identifier><language>eng</language><publisher>Toronto, ON: Canadian Anesthesiologists' Society</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. 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Our discussion explores the mechanisms and diagnosis of CAGE and the role of hyperbaric oxygen therapy. A diagnostic bronchoscopy was performed on a 70-yr-old man who had had a lobectomy for bronchogenic carcinoma three months earlier. During the direct insufflation of oxygen into the right middle lobe bronchus, the patient became unresponsive and developed subcutaneous emphysema. Immediately, an endotracheal tube and bilateral chest tubes were placed with resultant improvement in his oxygen saturation. However, he remained unresponsive with extensor and flexor responses to pain. Later, in the intensive care unit, he exhibited seizure activity requiring anticonvulsant therapy. Sedation was utilized only briefly to facilitate controlled ventilation. Investigations revealed a negative computerized tomography (CT) scan of the head, a normal cerebral spinal fluid examination, a CT chest that showed evidence of barotrauma, and an abnormal electroencephalogram. 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Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Barotrauma - complications</subject><subject>Barotrauma - etiology</subject><subject>Biological and medical sciences</subject><subject>Bronchoscopy</subject><subject>Bronchoscopy - adverse effects</subject><subject>Cardiac arrhythmia</subject><subject>Cerebral Arteries</subject><subject>Chest tubes</subject><subject>Electroencephalography</subject><subject>Embolism, Air - etiology</subject><subject>Embolism, Air - psychology</subject><subject>Embolism, Air - therapy</subject><subject>Embolisms</subject><subject>Emergency and intensive care: techniques, logistics</subject><subject>Emphysema</subject><subject>Extubation</subject><subject>Humans</subject><subject>Hyperbaric Oxygenation</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous System Diseases - chemically induced</subject><subject>Nervous System Diseases - pathology</subject><subject>Neurology</subject><subject>Oxygen saturation</subject><subject>Oxygen therapy</subject><subject>Pain Measurement</subject><subject>Patients</subject><subject>Perfusions. 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subjects Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Barotrauma - complications
Barotrauma - etiology
Biological and medical sciences
Bronchoscopy
Bronchoscopy - adverse effects
Cardiac arrhythmia
Cerebral Arteries
Chest tubes
Electroencephalography
Embolism, Air - etiology
Embolism, Air - psychology
Embolism, Air - therapy
Embolisms
Emergency and intensive care: techniques, logistics
Emphysema
Extubation
Humans
Hyperbaric Oxygenation
Intensive care
Intensive care medicine
Male
Medical sciences
Nervous System Diseases - chemically induced
Nervous System Diseases - pathology
Neurology
Oxygen saturation
Oxygen therapy
Pain Measurement
Patients
Perfusions. Catheterizations. Hyperbaric oxygenotherapy
Thoracic surgery
Tomography
Vascular diseases and vascular malformations of the nervous system
Ventilators
title Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen
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