Abstract：
OBJECTIVE: To report a case of systemic gas embolism associated with removal of a chest drain perforating a lung lobe in a dog undergoing sternotomy under general anesthesia and intermittent positive pressure ventilation.
METHODS: An 8-year-old Cocker Spaniel underwent an exploratory thoracotomy via median sternotomy for surgical management of pyothorax that was treated conservatively for 7 days prior to referral following bilateral chest drain placement. The surgical procedure consisted of a subphrenic mediastinectomy and pericardiectomy. During surgery, it became apparent that the right drain was perforating the right middle lung lobe. Sudden desaturation and rapid hemodynamic deterioration occurred after the drain was removed. A systemic gas embolism was suspected on the basis of clinical signs and results of an arterial blood gas analysis, and immediate supportive treatment was started with an adequate response. Once the surgical procedure was completed, a clear \"mill wheel\" sound was audible on cardiac auscultation and point-of-care cardiac ultrasound confirmed the presence of gas bubbles in the cardiac chambers. The dog recovered from anesthesia and was managed in the intensive care unit where arterial blood gas analyses were nearly normal and the dog made a full recovery.
CONCLUSIONS: In people, there are reports of fatal air embolism related to the use of chest drains. To our knowledge, this is the first case report in dogs of a systemic gas embolism during open-chest surgery caused by a chest drain perforating a lung lobe. Immediate recognition and aggressive treatment of this life-threatening condition should be provided in order to achieve a favorable outcome.
METHODS: An 8-year-old Cocker Spaniel underwent an exploratory thoracotomy via median sternotomy for surgical management of pyothorax that was treated conservatively for 7 days prior to referral following bilateral chest drain placement. The surgical procedure consisted of a subphrenic mediastinectomy and pericardiectomy. During surgery, it became apparent that the right drain was perforating the right middle lung lobe. Sudden desaturation and rapid hemodynamic deterioration occurred after the drain was removed. A systemic gas embolism was suspected on the basis of clinical signs and results of an arterial blood gas analysis, and immediate supportive treatment was started with an adequate response. Once the surgical procedure was completed, a clear \"mill wheel\" sound was audible on cardiac auscultation and point-of-care cardiac ultrasound confirmed the presence of gas bubbles in the cardiac chambers. The dog recovered from anesthesia and was managed in the intensive care unit where arterial blood gas analyses were nearly normal and the dog made a full recovery.
CONCLUSIONS: In people, there are reports of fatal air embolism related to the use of chest drains. To our knowledge, this is the first case report in dogs of a systemic gas embolism during open-chest surgery caused by a chest drain perforating a lung lobe. Immediate recognition and aggressive treatment of this life-threatening condition should be provided in order to achieve a favorable outcome.
摘要：
目的：报道一例在全身麻醉和间歇性正压通气下行胸骨切开术的犬，与切除贯穿肺叶的胸腔引流有关的全身性气体栓塞病例。
方法：一名8岁的可卡猎犬通过正中胸骨切开术进行了开胸探查术，以进行脓胸的手术治疗，在双侧胸腔引流后转诊前进行了7天的保守治疗。外科手术包括膈下纵隔切除术和心包切除术。手术期间,很明显，右引流在右中肺叶穿孔。拔除引流管后发生突然的去饱和和快速的血流动力学恶化。根据临床体征和动脉血气分析结果,怀疑有全身性气体栓塞,立即支持治疗开始时反应充分.一旦手术完成,心脏听诊时可听到清晰的“磨轮”声音,即时心脏超声证实心腔内存在气泡.狗从麻醉中恢复，并在重症监护病房接受治疗，动脉血气分析几乎正常，狗完全康复。
结论：在人们中，有报告说，与使用胸腔引流有关的致命空气栓塞。据我们所知,这是狗在开胸手术中发生的系统性气体栓塞的首例病例报告，原因是胸腔引流贯穿肺叶。应立即识别和积极治疗这种危及生命的状况，以实现有利的结果。
方法：一名8岁的可卡猎犬通过正中胸骨切开术进行了开胸探查术，以进行脓胸的手术治疗，在双侧胸腔引流后转诊前进行了7天的保守治疗。外科手术包括膈下纵隔切除术和心包切除术。手术期间,很明显，右引流在右中肺叶穿孔。拔除引流管后发生突然的去饱和和快速的血流动力学恶化。根据临床体征和动脉血气分析结果,怀疑有全身性气体栓塞,立即支持治疗开始时反应充分.一旦手术完成,心脏听诊时可听到清晰的“磨轮”声音,即时心脏超声证实心腔内存在气泡.狗从麻醉中恢复，并在重症监护病房接受治疗，动脉血气分析几乎正常，狗完全康复。
结论：在人们中，有报告说，与使用胸腔引流有关的致命空气栓塞。据我们所知,这是狗在开胸手术中发生的系统性气体栓塞的首例病例报告，原因是胸腔引流贯穿肺叶。应立即识别和积极治疗这种危及生命的状况，以实现有利的结果。
