0
Case Reports   |    
Fatal Venous Air Embolism During Shoulder ArthroscopyA Case Report
Benjamin Zmistowski, BS1; Luke Austin, MD1; Michael Ciccotti, BA1; Eric Ricchetti, MD1; Gerald Williams, Jr., MD1
1 Rothman Institute of Orthopaedics, Thomas Jefferson University, 925 Chestnut Street, 2nd Floor, Philadelphia, PA 19107. E-mail address for B. Zmistowski: zmistowski@gmail.com
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Stryker Orthopaedics, Johnson and Johnson, and Mitek).

Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Sep 01;92(11):2125-2127. doi: 10.2106/JBJS.I.01704
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Extract

Venous air embolism is a potential surgical complication when a negative pressure gradient exists between the surgical site and the right atrium of the heart. It occurs more commonly when the operative site is over the heart, the pressure of gas in the body cavity exceeds that of the venous sinusoids (15 to 30 mm Hg), air rather than carbon dioxide is injected, or the venous sinusoids of bone marrow are exposed1,2. Shoulder arthroscopy satisfies many of these criteria: the beach-chair and lateral decubitus positions place the surgical site over the right atrium, the standard settings for arthroscopic pumps are at pressures of >30 mm Hg, air bubbles are often observed entering the joint, and venous sinusoids are exposed anytime that osseous work (i.e., distal clavicular excision, acromioplasty, or fracture repair) is performed. Two case reports of fatal venous air embolism following knee arthroscopy3,4 with intentional air insufflation have appeared in the literature, but we are not aware of any reported case following liquid-only arthroscopy.
Figures in this Article

    First Page Preview

    View Large
    />
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    01/22/2014
    PA - Penn State Milton S. Hershey Medical Center
    02/05/2014
    OR - The Center - Orthopedic and Neurosurgical Care and Research
    02/10/2014
    IL - The University of Chicago's Department of Orthopaedic Surgery and Rehabilitation Medicine
    12/04/2013
    NY - Icahn School of Medicine at Mount Sinai