Not fatal venous air embolism after holmium laser enucleation of the prostate: Case report and review of literature

  • Daniele Romagnoli | danieleromagnoli87@gmail.com Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Mobin Ghaemian Anesthesiology and Postoperative Intensive Care Unit, Abano Terme Hospital, Abano Terme (PD),, Italy.
  • Daniele D'Agostino Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Paolo Corsi Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Marco Giampaoli Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Alessandro Del Rosso Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Matteo Cevenini Department of Specialistic, Experimental and Diagnostic Medicine, Urology, Alma Mater Studiorum-University of Bologna, S. Orsola Hospital, Bologna, Italy.
  • Riccardo Schiavina Department of Specialistic, Experimental and Diagnostic Medicine, Urology, Alma Mater Studiorum-University of Bologna, S. Orsola Hospital, Bologna, Italy.
  • Eugenio Brunocilla Department of Specialistic, Experimental and Diagnostic Medicine, Urology, Alma Mater Studiorum-University of Bologna, S. Orsola Hospital, Bologna, Italy.
  • Giorgio Davià Anesthesiology and Postoperative Intensive Care Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Walter Artibani Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.
  • Angelo Porreca Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD), Italy.

Abstract

Objective: Holmium laser has demonstrated high efficacy in urethral disobstruction. Venous air embolism (VAE) is a rare complication of prostate surgery. Only two cases of venous air embolism (VAE) in patients submitted to HoLEP, have been described. In this paper we show a third case of not fatal VAE after HoLEP.
Materials and methods: A case of VAE occurred in holmium laser enucleation (HoLEP) due to obstructive lower urinary tract symptoms (LUTS) in a 70 years old patient. After the procedure, patient’s end tidal carbon dioxide (ETCO2) levels dramatically decreased at 17 mmHg, with pressure airway (PAW)16 mmHg; oxygen saturation level was at 75%, without any loss in the ventilation circuit and with arterial blood pressure of 94/54 mmHg. Due to the negativity for other suspicions, the suspect of VAE was postulated.
Result: The immediate switching from laryngeal mask to Oro Tracheal Intubation increased the oxygen level. A cardiac transthoracic ultrasound was negative for air bubbles inside cardiac cavities, without any alteration in the cardiac kinetics. Arterial blood sample turned negative for any alteration compatible with VAE and catheter continuous vesical irrigation was started to obtain clear washing fluid without blood cloths. The extubated patient showed no neurological defects.
Conclusions: An invasive monitoring system is the key to rapidly and correctly identify any embolic episode during this kind of surgery.

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Published
2020-04-07
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Section
Case Reports
Keywords:
Holmium Laser enucleation of the prostate, Nitrogen embolus, Transurethral resection of the prostate, Urethral disobstruction, Venous embolism
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How to Cite
Romagnoli, D., Ghaemian, M., D’Agostino, D., Corsi, P., Giampaoli, M., Del Rosso, A., Cevenini, M., Schiavina, R., Brunocilla, E., Davià, G., Artibani, W., & Porreca, A. (2020). Not fatal venous air embolism after holmium laser enucleation of the prostate: Case report and review of literature. Archivio Italiano Di Urologia E Andrologia, 92(1), 55-57. https://doi.org/10.4081/aiua.2020.1.55

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