7 - The evils that bubbles do…

Abstract

Cerebral arterial gas embolism (CAGE) is a dramatic event with a very rapid onset of symptoms and occurs in diving and in a variety of medical procedures without the requirement for preceding supersaturation of tissues with inert gas. Decompression sickness (DCS) occurs only when there is prior accumulation of a gas-load in tissues (supersaturation) followed by subsequent depressurization, and bubbles mainly occur in the tissues and the venous side of the circulation. There is increasing evidence that microparticles, microbubbles, inflammatory mediators and ischemia-reperfusion injury all play important roles in CAGE and DCS. Gas embolism in the spinal cord is very rare, but a majority of DCS cases involve the spinal cord and this is often also accompanied by cerebral effects. The anatomy of the blood supply of the brain and spinal cord has important influences on CAGE and spinal DCS. The effects of bubbles occurring in cardiopulmonary bypass (CPB) are compared and contrasted with those seen in CAGE and DCS. Nine clinical case examples of CAGE and DCS are very briefly described and the outcomes are described in Chapter 9.