Systemic gaseous microemboli during left atrial catheterization: A common occurrence?

A. E. Feerick, J. A. Church, J. Zwischenberger, Vincent Conti, W. E. Johnston

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Gaseous microemboli during cardiac surgery have been implicated as a potential cause of postoperative neurologic injury. Any monitoring technique that exposes the systemic circulation to atmospheric pressure could introduce gaseous microemboli, causing cerebral microembolization. The incidence of carotid artery gaseous microemboli was studied during left atrial catheter insertion. Design: Prospective clinical study. Setting: Tertiary care university hospital. Participants: Twelve patients undergoing elective cardiac surgery. Interventions: Perioperatively, a 5-MHz continuous wave Doppler probe was positioned over the left carotid artery to maximally record blood flow signals. The criteria used for detecting a gaseous microembolus were a sudden increase in the amplitude of the visual signal by 30% and a characteristic audible sound. Measurements and Main Results: Numbers of microemboli at three timepoints (before and during left atrial catheter insertion and during catheter flushing) were assessed using the Friedman test. No emboli were detected before left atrial catheter insertion. When compared with the preinsertion time period, statistically (p < 0.05) significant numbers of gaseous microemboli were found in six patients during catheter insertion (3 ± 1 microemboli; range 1 to 7 microemboli) and in five patients during catheter flushing (5 ± 2 microemboli; range 1 to 12 microemboli). There was a tendency for patients with lower filling pressures to entrain more microemboli during insertion (r = 0.44; p = 0.149). No patient showed evidence of gross neurologic dysfunction postoperatively, although sensitive neurologic testing was not performed. Conclusions: Left atrial catheter insertion and flushing can cause systemic gaseous microemboli in more than 50% of patients. Although the number of microemboli introduced is relatively small, extreme care should be used during left atrial catheter insertion.

Original languageEnglish (US)
Pages (from-to)395-398
Number of pages4
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume9
Issue number4
DOIs
StatePublished - 1995

Fingerprint

Catheterization
Catheters
Carotid Arteries
Thoracic Surgery
Nervous System Trauma
Atmospheric Pressure
Tertiary Healthcare
Neurologic Manifestations
Embolism
Nervous System
Prospective Studies
Pressure
Incidence

Keywords

  • air
  • carotid arteries
  • left atrium
  • microemboli

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Systemic gaseous microemboli during left atrial catheterization : A common occurrence? / Feerick, A. E.; Church, J. A.; Zwischenberger, J.; Conti, Vincent; Johnston, W. E.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 9, No. 4, 1995, p. 395-398.

Research output: Contribution to journalArticle

Feerick, A. E. ; Church, J. A. ; Zwischenberger, J. ; Conti, Vincent ; Johnston, W. E. / Systemic gaseous microemboli during left atrial catheterization : A common occurrence?. In: Journal of Cardiothoracic and Vascular Anesthesia. 1995 ; Vol. 9, No. 4. pp. 395-398.
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abstract = "Objective: Gaseous microemboli during cardiac surgery have been implicated as a potential cause of postoperative neurologic injury. Any monitoring technique that exposes the systemic circulation to atmospheric pressure could introduce gaseous microemboli, causing cerebral microembolization. The incidence of carotid artery gaseous microemboli was studied during left atrial catheter insertion. Design: Prospective clinical study. Setting: Tertiary care university hospital. Participants: Twelve patients undergoing elective cardiac surgery. Interventions: Perioperatively, a 5-MHz continuous wave Doppler probe was positioned over the left carotid artery to maximally record blood flow signals. The criteria used for detecting a gaseous microembolus were a sudden increase in the amplitude of the visual signal by 30{\%} and a characteristic audible sound. Measurements and Main Results: Numbers of microemboli at three timepoints (before and during left atrial catheter insertion and during catheter flushing) were assessed using the Friedman test. No emboli were detected before left atrial catheter insertion. When compared with the preinsertion time period, statistically (p < 0.05) significant numbers of gaseous microemboli were found in six patients during catheter insertion (3 ± 1 microemboli; range 1 to 7 microemboli) and in five patients during catheter flushing (5 ± 2 microemboli; range 1 to 12 microemboli). There was a tendency for patients with lower filling pressures to entrain more microemboli during insertion (r = 0.44; p = 0.149). No patient showed evidence of gross neurologic dysfunction postoperatively, although sensitive neurologic testing was not performed. Conclusions: Left atrial catheter insertion and flushing can cause systemic gaseous microemboli in more than 50{\%} of patients. Although the number of microemboli introduced is relatively small, extreme care should be used during left atrial catheter insertion.",
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AU - Conti, Vincent

AU - Johnston, W. E.

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N2 - Objective: Gaseous microemboli during cardiac surgery have been implicated as a potential cause of postoperative neurologic injury. Any monitoring technique that exposes the systemic circulation to atmospheric pressure could introduce gaseous microemboli, causing cerebral microembolization. The incidence of carotid artery gaseous microemboli was studied during left atrial catheter insertion. Design: Prospective clinical study. Setting: Tertiary care university hospital. Participants: Twelve patients undergoing elective cardiac surgery. Interventions: Perioperatively, a 5-MHz continuous wave Doppler probe was positioned over the left carotid artery to maximally record blood flow signals. The criteria used for detecting a gaseous microembolus were a sudden increase in the amplitude of the visual signal by 30% and a characteristic audible sound. Measurements and Main Results: Numbers of microemboli at three timepoints (before and during left atrial catheter insertion and during catheter flushing) were assessed using the Friedman test. No emboli were detected before left atrial catheter insertion. When compared with the preinsertion time period, statistically (p < 0.05) significant numbers of gaseous microemboli were found in six patients during catheter insertion (3 ± 1 microemboli; range 1 to 7 microemboli) and in five patients during catheter flushing (5 ± 2 microemboli; range 1 to 12 microemboli). There was a tendency for patients with lower filling pressures to entrain more microemboli during insertion (r = 0.44; p = 0.149). No patient showed evidence of gross neurologic dysfunction postoperatively, although sensitive neurologic testing was not performed. Conclusions: Left atrial catheter insertion and flushing can cause systemic gaseous microemboli in more than 50% of patients. Although the number of microemboli introduced is relatively small, extreme care should be used during left atrial catheter insertion.

AB - Objective: Gaseous microemboli during cardiac surgery have been implicated as a potential cause of postoperative neurologic injury. Any monitoring technique that exposes the systemic circulation to atmospheric pressure could introduce gaseous microemboli, causing cerebral microembolization. The incidence of carotid artery gaseous microemboli was studied during left atrial catheter insertion. Design: Prospective clinical study. Setting: Tertiary care university hospital. Participants: Twelve patients undergoing elective cardiac surgery. Interventions: Perioperatively, a 5-MHz continuous wave Doppler probe was positioned over the left carotid artery to maximally record blood flow signals. The criteria used for detecting a gaseous microembolus were a sudden increase in the amplitude of the visual signal by 30% and a characteristic audible sound. Measurements and Main Results: Numbers of microemboli at three timepoints (before and during left atrial catheter insertion and during catheter flushing) were assessed using the Friedman test. No emboli were detected before left atrial catheter insertion. When compared with the preinsertion time period, statistically (p < 0.05) significant numbers of gaseous microemboli were found in six patients during catheter insertion (3 ± 1 microemboli; range 1 to 7 microemboli) and in five patients during catheter flushing (5 ± 2 microemboli; range 1 to 12 microemboli). There was a tendency for patients with lower filling pressures to entrain more microemboli during insertion (r = 0.44; p = 0.149). No patient showed evidence of gross neurologic dysfunction postoperatively, although sensitive neurologic testing was not performed. Conclusions: Left atrial catheter insertion and flushing can cause systemic gaseous microemboli in more than 50% of patients. Although the number of microemboli introduced is relatively small, extreme care should be used during left atrial catheter insertion.

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