Stroke following anaesthesia – possible air entrainment by faulty fluid warmer
Case
[Patient in their 30s] had a hernia repaired under combined GA and spinal anaesthesia. Once the procedure had finished and the patient woken up, they complained of being unable to move their legs. This was initially ascribed to the spinal administered for post-operative pain relief.
Hours later, the patient reported weakness and numbness in one hand and leg. An acute ischaemic stroke was suspected however CT scans of the brain and aorta, a carotid angiogram and trans-thoracic echocardiogram were reported as normal.
A differential diagnosis of air embolism was suggested as during the anaesthetic it was noted that the fluid warmer, one commonly used in theatres, was releasing some small bubbles into the drip line and had been immediately removed from the circuit.
Because of the inexplicable stroke in a young patient without risk factors, hyperbaric oxygen treatment (HBOT) was initiated as a matter of urgency, as a delay of >12 hours reduces the efficacy of such treatment. The patient tolerated the treatment well and reported slight improved ability to move the left hand and leg.
Commentary
Readers are reminded that air embolism is possible following any invasive procedure. Guidelines for managing air embolism are described in the Quick Reference Handbook.1
Reference