Abstract SNACC-88

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A novel device to prevent air embolism in the sitting position

Eckle V, Wendel H, Grasshoff C
Eberhard-Karls-University, Tübingen, , Germany

Background: Neurosurgical procedures requiring a sitting position might bring the patient at risk of potentially life-threatening air embolism (Mirski et al., 2007). Transiently manual jugular venous compression limits further air entry in this situation (Losasso et al., 1992). This study presents an alternative technique for preventing air embolism (Eckle and Grasshoff, 2012).

Methods: All procedures were performed in accordance with institutional and federal guidelines, including the German law on animal experimentation, and were approved by the Animal Care Committee (Eberhard-Karls-University, Tübingen, Germany) and the Regierungspräsidium Tübingen. In an in vitro model, an intrajugular balloon catheter was inserted to test the hypothesis that this device prevents air embolism. In a set of experiments in vivo, the intrajugular balloon catheter was bilaterally placed in the Vv. jugulares externae in swine. Using ultrasound technique, the obstruction of the vessel induced by inflated cuffs was monitored and the jugular venous pressure was recorded up to 5 minutes.

Results: The intrajugular balloon catheter reliably prevented further air entry in 100% of the experiments in vitro (n=10). Additionally, accumulated air could be aspirated by an orifice of the catheter (n=10). In vivo, ultrasound recordings revealed that the intrajugular flow could be completely paused (n=4). In this ongoing study, the proximal intrajugular venous pressure significantly increased about 35.4±7.9% during bilateral cuff inflation proving the obstruction (n=4, p<0.03).

Discussion: This in vitro and in vivo study provides evidence for the functionality of an intrajugular balloon catheter. An intrajugular balloon catheter combines the functionality of the jugular venous compression maneuver and a central venous line. These findings might serve as a starting point for the development of intrajugular balloon catheters to be used for patients undergoing neurosurgery in the sitting position.

References:
Eckle, V.-S., Grasshoff, C. (2012). J Neurosurg Anesthesiol 24, 81–82.
Losasso, T., et al. (1992). Anesthesiology 76, 156–157.
Mirski, M., et al. (2007). Anesthesiology 106, 164–177.


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