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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
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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
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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.
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    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.
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