AANA journal
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Review Case Reports
Acute circulatory and respiratory collapse in obstetrical patients: a case report and review of the literature.
Venous air embolism is the entrapment of air into the venous system producing signs and symptoms due to obstruction of pulmonary arterial blood flow. We present a healthy, 27-year-old, full-term parturient admitted for postdate induction of labor. Cesarean delivery was required following fetal distress. ⋯ The diagnosis may be facilitated by precordial Doppler monitoring, transesophageal echocardiography, or by the identification of air when aspirating from a right heart catheter. Management includes optimum patient positioning, aspiration of air, discontinuation of nitrous oxide, administration of 100% oxygen, and flooding the surgical site with saline to avoid further air entry. Preventive strategies are also discussed.
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The esophageal Doppler monitor is a recent development in hemodynamic monitoring that is used for surgical patients. It is relatively noninvasive and measures descending aortic blood flow by the Doppler effect. A comparison of this new monitor with the pulmonary artery catheter is cited numerous times throughout the literature and overall correlates well. Studies of the esophageal Doppler monitor show it to be a safe addition to operating room monitors for use by the anesthetist.