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[Antishock trousers in the prevention of air embolism]
1Département d'Anesthésie-Réanimation, Hôpital des Enfants-Malades, Paris.
Insights
Military anti-shock trousers (MAST) effectively prevent venous air embolism in pediatric neurosurgery. The study found MAST inflation increased venous pressure, preventing air emboli without adverse effects.
Area of Science:
- Anesthesiology
- Pediatric Neurosurgery
- Vascular Surgery
Context:
- Neurosurgical procedures in the sitting position carry a risk of venous air embolism.
- Monitoring central venous pressure is crucial for detecting air embolism.
- Pediatric patients present unique challenges in managing this risk.
Purpose:
- To evaluate the efficacy and safety of military anti-shock trousers (MAST) in preventing venous air embolism.
- To assess the impact of MAST inflation on venous pressure and air embolism detection.
- To determine the feasibility of using MAST in pediatric neurosurgery.
Summary:
- Military anti-shock trousers (MAST) inflation significantly increased venous pressure, preventing detectable venous air emboli in pediatric neurosurgery patients.
- Hemodynamic measurements confirmed that MAST inflation, combined with PEEP and fluid administration, created sufficient pressure to occlude venous entry.
- No adverse effects were observed, indicating the safety of MAST in this context.
Impact:
- MAST application appears to be an effective method for mitigating the risks associated with the sitting position in pediatric neurosurgery.
- The study highlights the potential of MAST to preserve the benefits of the sitting position while reducing its inherent dangers.
- Limited availability of pediatric-sized MAST restricts its widespread clinical application, necessitating further development or alternative solutions.
Abstract:
This study aimed to assess the efficiency and safety of military anti-shock trousers (MAST) in preventing venous air embolism in children undergoing neurosurgical procedures in the sitting position. It included 26 children, 7.7 +/- 4-year-old and weighing 25.4 +/- 10.5 kg. All had the same anaesthetic protocol including premedication with oral lorazepam, induction with thiopentone or propofol with fentanyl and vecuronium, and maintenance with isoflurane and a continuous infusion of fentanyl. In 10 patients, a retrograde central venous catheter was inserted for measurement of pressure in the superior bulb of the internal jugular vein. Haemodynamic measurements were carried out with the patient supine; with the patient sitting, the MAST not being inflated; 10 min after inflation of the MAST (40 mmHg in the limbs, 30 mmHg in the abdominal part); after starting 10 cmH2 O positive end expiratory pressure; and after fluid administration with 5 ml.kg-1 macromolecules (Plasmion). The criterion for air embolism was a decrease in PetCO2 of more than 5 mmHg over more than 30 s, not preceded by respiratory or cardiovascular impairment. Inflation of the MAST resulted in a dramatic rise in venous pressure, still reinforced by minor PEEP. Transmission of pressure from the right atrium to the dural sinus was linear, and seemed to be sufficient to prevent occurrence of detectable venous air emboli. No deleterious side-effects were noted. This method would therefore seem to be very efficient, preserving the advantages of the sitting position, and restricting its disadvantages. Unfortunately, the limited availability of different paediatric sizes of MAST reduces the possible uses of this method.