Iatrogenic cerebral arterial gas embolism from flushing of the arterial line in two calves.

Casoni, Daniela; Mirra, Alessandro; Göpfert, Christine; Petruccione, Ilaria; Spadavecchia, Claudia (2018). Iatrogenic cerebral arterial gas embolism from flushing of the arterial line in two calves. Acta Veterinaria Scandinavica, 60(1), p. 51. BioMed Central Ltd. 10.1186/s13028-018-0405-5

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BACKGROUND Measurement of invasive blood pressure as reflection of blood flow and tissue perfusion is often carried out in animals during general anesthesia. Intravascular cannulation offers the potential for gas to directly enter the circulation and lead to arterial gas embolism. Cerebral arterial gas embolism may cause a spectrum of adverse effects ranging from very mild symptoms to severe neurological injury and death. Although several experimental models of arterial gas embolism have been published, there are no known published reports of accidental iatrogenic cerebral arterial gas embolism from flushing of an arterial line in animals. CASE PRESENTATION A 7-day-old Red Holstein-Friesian calf (No. 1) and a 28-day-old Holstein-Friesian calf (No. 2) underwent hot iron disbudding and sham disbudding, respectively, under sedation and cornual nerve anesthesia. Invasive arterial blood pressure was measured throughout the procedure and at regular intervals during the day. Before disbudding, a sudden and severe increase of blood pressure was observed following flushing of the arterial line. Excitation, hyperextension of the limbs and rapid severe horizontal nystagmus appeared shortly thereafter. Over the following minutes, symptoms ameliorated and blood pressure normalized in both cases. Prompt diagnosis was missed in calf 1; supportive fluid therapy was provided. Severe deterioration of neurologic status occurred in the following 24 h and culminated with stupor. The calf was euthanized for ethical reasons and the histological examination revealed extensive cerebral injury. Treatment of calf 2 consisted of supportive fluid and oxygen therapy; furosemide (1 mg/kg IV) was injected twice. Calf 2 appeared clinically normal after 2 h and showed no neurologic sequelae on a 3-month-follow up period. CONCLUSIONS There are no known reports of cerebral arterial gas embolism following flushing of the auricular arterial line in calves. The injection of a small amount of air at high pressure in a peripheral artery may lead to a significant cerebral insult. The clinical presentation is non-specific and can favour misdiagnosis and delay of therapy.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR)
05 Veterinary Medicine > Department of Clinical Veterinary Medicine (DKV)
05 Veterinary Medicine > Department of Infectious Diseases and Pathobiology (DIP) > Institute of Animal Pathology
05 Veterinary Medicine > Department of Infectious Diseases and Pathobiology (DIP)
05 Veterinary Medicine > Department of Clinical Veterinary Medicine (DKV) > DKV - Anaesthesiology

UniBE Contributor:

Casoni, Daniela; Mirra, Alessandro; Göpfert, Christine; Petruccione, Ilaria and Spadavecchia, Claudia

Subjects:

600 Technology > 630 Agriculture
600 Technology > 610 Medicine & health

ISSN:

1751-0147

Publisher:

BioMed Central Ltd.

Language:

English

Submitter:

Marla Rittiner

Date Deposited:

06 Feb 2019 09:57

Last Modified:

05 Nov 2019 06:17

Publisher DOI:

10.1186/s13028-018-0405-5

PubMed ID:

30189865

Uncontrolled Keywords:

Calf Cerebral infarcts DIC Gas embolism Invasive blood pressure

BORIS DOI:

10.7892/boris.124492

URI:

https://boris.unibe.ch/id/eprint/124492

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