Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000100008
Brazilian Journal of Anesthesiology
Clinical Information

Embolia aérea arterial durante anestesia para marcação percutânea de nódulo pulmonar: relato de caso

Arterial air embolism during anesthesia for percutaneous pulmonary node location: case report

Mônica Rossi Rodrigues; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942003000100008 Braz J Anesthesiol, vol.53, n1, p.58-62, 2003
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JUSTIFICATIVA E OBJETIVOS: A embolia aérea arterial é uma complicação que pode ocorrer durante diversos tipos de procedimentos cirúrgicos e está relacionada à alta incidência de morbidade e mortalidade. O objetivo deste relato é mostrar um caso de embolia aérea arterial durante anestesia geral para marcação percutânea de nódulo pulmonar guiada por tomografia computadorizada. RELATO DO CASO: Paciente de 33 anos, do sexo masculino, estado físico ASA II, foi submetido à marcação percutânea de nódulo pulmonar (provável metástase de tumor de células gigantes do fêmur) com agulha gancho, sob anestesia geral. A indução anestésica foi realizada sem dificuldades e com o paciente em decúbito lateral direito, o procedimento foi iniciado. Após a instalação do gancho, enquanto os cirurgiões verificavam seu posicionamento com novas imagens de tomografia, foram observadas hipotensão arterial e bradicardia, seguidas de assistolia. Foram realizadas manobras de reanimação, drenagem torácica e ecocardiografia transtorácica. Em um dos cortes tomográficos mais recentes foi visualizada presença de ar no interior da aorta descendente. Após 15 minutos de reanimação houve reversão do quadro. O paciente foi encaminhado à UTI e 6 dias após recebeu alta hospitalar sem seqüelas. CONCLUSÕES: A embolia aérea arterial é uma complicação de vários procedimentos e na maioria deles o paciente está sob anestesia geral. O anestesiologista deve estar preparado para reconhecer as alterações envolvidas e fazer o diagnóstico diferencial. A instituição de medidas terapêuticas oportunas e adequadas são fundamentais para a redução da morbidade e da mortalidade decorrentes deste evento.

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COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Arterial air embolism is a complication that may occur during several surgical procedures and is associated to a high morbidity and mortality rate. This report aimed at presenting a case of arterial air embolism during general anesthesia for percutaneous CT-guided location of a pulmonary node. CASE REPORT: Male patient, 33 years old, physical status ASA II, was submitted to percutaneous location of a pulmonary node (probably a femoral giant cell tumor metastasis) with the hook-wire technique under general anesthesia. Anesthesia was induced without difficulties and the procedure was started with the patient in the right lateral position. After hook insertion, while the surgeons checked its positioning with CT images, arterial hypotension and bradycardia followed by asystole was observed. Cardiopulmonary resuscitation maneuvers, thoracic drainage and transthoracic echocardiography were performed. The presence of air in the descending aorta was seen at a later CT image. Cardiac arrest was reversed 15 minutes after resuscitation maneuvers. Patient was referred to the ICU and discharged 6 days later without sequelae. CONCLUSIONS: Arterial air embolism is a complication of different procedures most of them performed with the patient under general anesthesia. Anesthesiologists must be prepared to recognize involved problems and make the differential diagnosis. Suitable and adequate treatment is critical to decrease morbidity and mortality associated to this event.

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COMPLICATIONS

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