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Online ISSN 1827-1596
Bechi A. 1, Nucera M. P. 1, Olivotto I. 2, Manetti R. 3, Fabbri L. P. 1
1 Department of Anesthesia and Intensive Care, Careggi Hospital, Florence, Italy;
2 Department of Cardiology, Careggi Hospital, Florence, Italy;
3 Department of General Surgery, Careggi Hospital, Florence, Italy
Systemic air embolisms are a rare but often a fatal complication of endoscopic retrograde cholangiopancreatography (ERCP). Only few cases have been reported in scientific studies. This paper concerns a case of a systemic air embolism that occurred during endoscopic sphincterotomy for gallstone removal in a 79-year-old-woman and discusses possible mechanisms. The basic vital and neurologic signs of the woman deteriorated abruptly towards the end of the procedure. It was believed to be an air embolism and an urgent transthoracic echocardiography was ordered which confirmed the etiological diagnosis. Supportive measures were initiated: she was administered 100% oxygen, she was placed head down, left lateral position and fluid resuscitation was started to increase venous pressure. We considered hyperbaric oxygen therapy for neurological injury but, despite the severe initial presentation, she had a complete clinical recovery with only conservative treatment. Present experience stresses the importance of the awareness of this uncommon complication: a close vigilance of the anesthetists during ERCP is critical to ensure early diagnosis and a timely intervention.