PATHOGENESIS OF SYSTEMIC AIR-EMBOLISM DURING BRONCHOSCOPIC ND-YAG LASER OPERATIONS

Background. The occurrence of systemic air embolism during bronchoscop ic neodymium:yttrium-aluminum garnet laser operations has been suspect ed. Here we describe its mechanism. Methods. Two patients with embolic cardiac and neurologic complications after bronchoscopic neodymium: y ttrium-aluminum garnet laser tumor ablation are described. A subsequen t third patient tvas monitored for intracardiac and aortic air by tran sesophageal echocardiography. A review of the literature and safety re commendations are discussed. Results. The appearance of systemic air e mboli was related to the use of the laser fiber air coolant at high fl ow and resolved by decreasing the air flow. The presence of intracardi ac and aortic air was associated with hypotension and inferior ischemi c electrocardiographic changes. Conclusions. Systemic air embolism dur ing bronchoscopic laser operations is a potentially catastrophic compl ication and is related to the use oi: gas-cooled laser fibers and cont act probes. We recommend using the noncontact mode whenever possible a nd maintaining the coaxial coolant air now at the minimum level or usi ng a fluid coolant if contact is necessary. (C) 1998 by The Society of Thoracic Surgeons.