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 |
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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. |
doi_str_mv | 10.1007/BF03020427 |
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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. 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</subject><ispartof>Canadian journal of anesthesia, 2002, Vol.49 (1), p.96-99</ispartof><rights>2002 INIST-CNRS</rights><rights>Canadian Anesthesiologists 2002</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c376t-13edd78b9af4c10bff3620be01d64518fb13798c61c05c8ddc2d7a1943cf10703</citedby><cites>FETCH-LOGICAL-c376t-13edd78b9af4c10bff3620be01d64518fb13798c61c05c8ddc2d7a1943cf10703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,4012,27906,27907,27908</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13442868$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11782337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>WHERRETT, Chris G</creatorcontrib><creatorcontrib>MEHRAN, Reza J</creatorcontrib><creatorcontrib>BEAULIEU, Marc-Andre</creatorcontrib><title>Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen</title><title>Canadian journal of anesthesia</title><addtitle>Can J Anaesth</addtitle><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.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. 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. Catheterizations. Hyperbaric oxygenotherapy</subject><subject>Thoracic surgery</subject><subject>Tomography</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><subject>Ventilators</subject><issn>0832-610X</issn><issn>1496-8975</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpF0MtKw0AUBuBBFK3VjQ8gg-BGiJ65dGbiTos3ENwouAtzbVOSTJ1J0by9EQtdnbP4-A_nR-iMwDUBkDf3j8CAAqdyD00IL0WhSjnbRxNQjBaCwOcROs55BQBKzNQhOiJEKsqYnKDV3Cdvkm6wTr1P9bgsdMa-NbGpc4tDbJr4XXcL7Gq96GLua4tNip1dxmzjerjFzjd68A73yeu-9V2Pv-t-iZfD2iej0-jjz7Dw3Qk6CLrJ_nQ7p-jj8eF9_ly8vj29zO9eC8uk6AvCvHNSmVIHbgmYEJigYDwQJ_iMqGAIk6WygliYWeWcpU5qUnJmAwEJbIou_nPXKX5tfO6rVdykbjxZlZRwQfn4-hRd_SObYs7Jh2qd6lanoSJQ_bVa7Vod8fk2cWNa73Z0W-MILrdAZ6ubkHRn67xzjHOqhGK_LYiAWg</recordid><startdate>2002</startdate><enddate>2002</enddate><creator>WHERRETT, Chris G</creator><creator>MEHRAN, Reza J</creator><creator>BEAULIEU, Marc-Andre</creator><general>Canadian Anesthesiologists' Society</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>2002</creationdate><title>Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen</title><author>WHERRETT, Chris G ; MEHRAN, Reza J ; BEAULIEU, Marc-Andre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c376t-13edd78b9af4c10bff3620be01d64518fb13798c61c05c8ddc2d7a1943cf10703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Barotrauma - complications</topic><topic>Barotrauma - etiology</topic><topic>Biological and medical sciences</topic><topic>Bronchoscopy</topic><topic>Bronchoscopy - adverse effects</topic><topic>Cardiac arrhythmia</topic><topic>Cerebral Arteries</topic><topic>Chest tubes</topic><topic>Electroencephalography</topic><topic>Embolism, Air - etiology</topic><topic>Embolism, Air - psychology</topic><topic>Embolism, Air - therapy</topic><topic>Embolisms</topic><topic>Emergency and intensive care: techniques, logistics</topic><topic>Emphysema</topic><topic>Extubation</topic><topic>Humans</topic><topic>Hyperbaric Oxygenation</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous System Diseases - chemically induced</topic><topic>Nervous System Diseases - pathology</topic><topic>Neurology</topic><topic>Oxygen saturation</topic><topic>Oxygen therapy</topic><topic>Pain Measurement</topic><topic>Patients</topic><topic>Perfusions. Catheterizations. Hyperbaric oxygenotherapy</topic><topic>Thoracic surgery</topic><topic>Tomography</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WHERRETT, Chris G</creatorcontrib><creatorcontrib>MEHRAN, Reza J</creatorcontrib><creatorcontrib>BEAULIEU, Marc-Andre</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Canadian journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WHERRETT, Chris G</au><au>MEHRAN, Reza J</au><au>BEAULIEU, Marc-Andre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen</atitle><jtitle>Canadian journal of anesthesia</jtitle><addtitle>Can J Anaesth</addtitle><date>2002</date><risdate>2002</risdate><volume>49</volume><issue>1</issue><spage>96</spage><epage>99</epage><pages>96-99</pages><issn>0832-610X</issn><eissn>1496-8975</eissn><coden>CJOAEP</coden><abstract>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.</abstract><cop>Toronto, ON</cop><pub>Canadian Anesthesiologists' Society</pub><pmid>11782337</pmid><doi>10.1007/BF03020427</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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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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