Abstract
Purpose
A first case of massive venous air embolism is reported as a complication of orthotopic liver transplantation in a 17-month-old child during the dissection phase.
Clinical features
During the hepatic dissection phase, perforation of suprahepatic veins was responsible for an air embolism with a decrease of PETCO2 (27 to 6 mmHg), hypoxaemia (SpO2 decreased from 100 to 88%), and haemodynamic instability (systolic blood pressure decreased from 85 to 50 mmHg, central venous pressure increased from 6 to 10 mmHg). Central venous aspiration of air was unsuccessful but iminediate resolution occurred and neurological outcome was normal.
Conclusion
Venous air embolism dunng the dissection phase of liver transplantation in children is a risk that should be considered.
Résumé
Objectif
Rapporter une première observation d’embolie aérienne survenant à la phase de dissection du foie chez un enfant de 17 mois pendant une transplantation hépatique orthoptique.
Éléments cliniques
Pendant la phase de dissection du foie, une perforation des veines sus-hépatiques a provoqué une embolie aérienne avec une chute de la PETCO2 (27 à 6 mmHg), une hypoxémie (une chute de la SpO2 de 100 à 88%), de l’instabilité hémodynamique (la pression arténelle systolique s’abaissant de 85 à 50 mmHg, la tension veineuse centrale augmentant de 6 à 10 mmHg). L’aspiration centrale d’air a été un échec mais la situation s’est rétablie immédiatement et l’évolution neurologique a été normale.
Conclusion
Pendant la phase de dissection de la transplantation hépatique, il faut tenir compte du risque d’embolie gazeuse survenant par la voie veineuse.
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Souron, V., Fletcher, D., Goujard, E. et al. Venous air embolism during orthotopic liver transplantation in a child. Can J Anesth 44, 1187–1190 (1997). https://doi.org/10.1007/BF03013343
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DOI: https://doi.org/10.1007/BF03013343