Lowenwirt I P, Chi D S, Handwerker S M
Department of Anesthesia, New York Hospital Medical Center of Queens, Flushing 11355.
Obstet Gynecol Surv. 1994 Jan;49(1):72-6. doi: 10.1097/00006254-199401000-00028.
Venous air embolism occurs in more than half of all cesarean sections. Predisposing factors in pregnancy include uterine surgery and manipulation, hypovolemia, and maternal positioning. The presence of an intracardiac septal defect and use of certain anesthetic agents place the patient at greater risk of fatal air embolus. The sudden development of hypotension, hypoxia, and a drop in end-tidal CO2 are typical signs of this condition. Supportive therapy includes flooding the surgical field with normal saline, placing the patient in reverse Trendelenburg with a left-lateral tilt, and discontinuation of nitrous oxide anesthesia. We report a case that was diagnosed and successfully managed during a cesarean section and review the literature on prophylaxis, diagnosis, and therapy of this condition. A high index of suspicion and use of precordial Doppler studies in the future will permit earlier diagnosis and therapy and decreased mortality from this common condition. The phenomenon of venous air embolism in the intrapartum period has been well described in the anesthesia literature but there have been few case reports of patients having this complication in the recent obstetrical literature. We wish to describe the clinical course and successful management of a patient with this complication during cesarean section and provide a review of the literature on the phenomenon of venous air embolism in the obstetrical patient with particular emphasis on pathophysiology, detection, and treatment.
超过半数的剖宫产手术会发生静脉空气栓塞。孕期的诱发因素包括子宫手术与操作、血容量不足以及产妇体位。存在心内间隔缺损和使用某些麻醉剂会使患者面临更高的致命空气栓塞风险。低血压、低氧血症以及呼气末二氧化碳分压下降的突然出现是这种情况的典型体征。支持性治疗包括用生理盐水冲洗手术视野、将患者置于头低脚高仰卧位并向左倾斜、停止氧化亚氮麻醉。我们报告了一例在剖宫产手术期间被诊断并成功处理的病例，并回顾了关于这种情况的预防、诊断和治疗的文献。未来高度的怀疑指数和使用心前区多普勒检查将有助于更早地诊断和治疗，并降低这种常见病症的死亡率。分娩期静脉空气栓塞现象在麻醉文献中有详细描述，但近期产科文献中关于患者发生这种并发症的病例报告较少。我们希望描述一名剖宫产手术期间发生这种并发症的患者的临床过程和成功处理方法，并提供关于产科患者静脉空气栓塞现象的文献综述，特别强调病理生理学、检测和治疗。
