Luo Li-Hui, Peng Zhi-You, Zhu Sheng-Mei, Yao Yong-Xing
Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
Medicine (Baltimore). 2018 Sep;97(39):e12639. doi: 10.1097/MD.0000000000012639.
Although venous air embolism (VAE) during liver operation has been reported occasionally, fatal VAE in hepatic resection is uncommon. Prompt detection of VAE by transesophageal echocardiography (TEE) is crucial for effective therapy. We describe a case of fatal VAE that caused repeated cardiac arrest during hepatic resection and was confirmed by TEE.
A 51-year-old woman with a body weight of 50 kg underwent partial liver resection due to intrahepatic duct calculus. She had a 1-year history of intrahepatic duct calculus without cardiopulmonary disease. The operation was performed under general anesthesia combined with epidural block. When the inferior vena cava was compressed, the PetCO2 level decreased abruptly from 30 to 10 mmHg, followed by a decrease in SpO2 and the development of hypotension. Her heart rate increased with ST interval elevation on electrocardiography monitoring. Ephedrine and phenylephrine were administered immediately but had little effect. Cardiac arrest occurred.
Air embolism was detected by TEE.
Resuscitation was successful although cardiac arrest occurred repeatedly.
The patient returned to consciousness 6 hours postoperatively but died of multiorgan dysfunction 10 days later.
Fatal air embolism may happen during hepatic resection. Prompt detection of VAE by TEE is crucial for effective therapy and should always be available during hepatic resection.
尽管肝手术期间静脉空气栓塞（VAE）偶有报道，但肝切除术中致命性VAE并不常见。经食管超声心动图（TEE）迅速检测到VAE对于有效治疗至关重要。我们描述了1例在肝切除术中导致反复心脏骤停并经TEE证实的致命性VAE病例。
一名体重50kg的51岁女性因肝内胆管结石接受部分肝切除术。她有1年肝内胆管结石病史，无心肺疾病。手术在全身麻醉联合硬膜外阻滞下进行。当压迫下腔静脉时，呼气末二氧化碳分压（PetCO2）水平突然从30mmHg降至10mmHg，随后血氧饱和度（SpO2）下降并出现低血压。心电图监测显示心率加快伴ST段抬高。立即给予麻黄碱和去氧肾上腺素，但效果不佳。发生心脏骤停。
TEE检测到空气栓塞。
尽管反复发生心脏骤停，但复苏成功。
患者术后6小时恢复意识，但10天后死于多器官功能障碍。
肝切除术中可能发生致命性空气栓塞。TEE迅速检测到VAE对于有效治疗至关重要，在肝切除术中应始终具备该检查手段。
