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Ann Thorac Surg 1998;65:930-934
© 1998 The Society of Thoracic Surgeons

Pathogenesis of Systemic Air Embolism During Bronchoscopic Nd:YAG Laser Operations

George Tellides, MDa, Baran S. Ugurlu, MDa, Richard W. Kim, MDa, Graeme L. Hammond, MDa

a Section of Cardiothoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA

Accepted for publication November 20, 1997.

Address reprint requests to Dr Tellides, Section of Cardiothoracic Surgery, Department of Surgery, Yale University School of Medicine, 333 Cedar St, 121 FMB, New Haven, CT 06510
e-mail: (george.tellides {at}yale.edu)

Background. The occurrence of systemic air embolism during bronchoscopic neodymium:yttrium-aluminum garnet laser operations has been suspected. Here we describe its mechanism.

Methods. Two patients with embolic cardiac and neurologic complications after bronchoscopic neodymium:yttrium-aluminum garnet laser tumor ablation are described. A subsequent third patient was monitored for intracardiac and aortic air by transesophageal echocardiography. A review of the literature and safety recommendations are discussed.

Results. The appearance of systemic air emboli was related to the use of the laser fiber air coolant at high flow and resolved by decreasing the air flow. The presence of intracardiac and aortic air was associated with hypotension and inferior ischemic electrocardiographic changes.

Conclusions. Systemic air embolism during bronchoscopic laser operations is a potentially catastrophic complication and is related to the use of gas-cooled laser fibers and contact probes. We recommend using the noncontact mode whenever possible and maintaining the coaxial coolant air flow at the minimum level or using a fluid coolant if contact is necessary.






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