Massive air embolism during off-pump CABG: A case report

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Medical Devices

Background:

• Off-pump coronary artery bypass grafting (OPCAB) avoids cardiopulmonary bypass (CPB) complications but introduces technical and anesthetic challenges.
• Maintaining tissue stabilization and managing hemodynamic instability during OPCAB are complex.
• Achieving a clear surgical field during arteriotomy in OPCAB can be difficult.

Observation:

• Catheter-directed high-flow gas blowers (mister blowers) are used to improve surgical field visualization during OPCAB.
• While effective for visualization, high-flow gas blowers have been associated with reported cases of arterial and pulmonary embolism.
• This case report documents a massive venous air embolism linked to the use of a mister blower.

Findings:

• The use of a mister blower during OPCAB surgery led to a massive venous air embolism.
• This complication highlights a significant risk associated with visualization tools in beating-heart surgery.

Implications:

• Anesthetic management protocols for OPCAB may need to incorporate strategies to mitigate air embolism risks from gas blowers.
• Further research into the safety and efficacy of visualization devices in OPCAB is warranted.
• This case underscores the importance of vigilance for rare but serious complications in minimally invasive cardiac procedures.