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  1. Re:Comment to "Fatal air embolism following local anaesthetisation: does needle size matter?

    I greatly appreciate the well-advised comments from the reader on my case report, ''Fatal air embolism following local anaesthetisation: does needle size matter?''. (1) They discuss the significance of proper positioning prior to performing the biopsy. While having the appropriate hemithorax in ipsilateral-dependent position certainly minimizes the motion and reduces the risk of air embolism as the core biopsy needle traverses the lung parenchyma; our case report was meant to emphasize the risk of air embolism during the administration of local anesthetic where the needle typically does not penetrate any significant portion of lung parenchyma. Since 25-gauge needle is very small and usually not linked to air embolisms, we discussed that all the risk factors (including improper positioning) that are associated with air embolism during core biopsy are applicable to smaller Lidocaine needle as well. In our patient, it is likely that positioning in addition to negative intra-thoracic pressure generated by patient's cough resulted in air embolism.

    1. Khalid F, Rehman S, AbdulRahman R, Gupta S. Fatal air embolism following local anaesthetisation: does needle size matter? BMJ Case Rep. 2018;2018.

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  2. Comment to "Fatal air embolism following local anaesthetisation: does needle size matter?

    I read with interest your case report (1), however I have to make the critical comment, that patient position in your case indeed was one essential factor of air embolism. You attempted to biopsy a lung nodule of the left lower lobe in dorso- lateral position with patient placed in prone oblique position on the right side. You should have placed patient in ipsilateral-dependent position, in other words on the side of the nodule, which is the left side! Only in this position the motion of the appropriate hemithorax is reduced and only in this position the biopsy can be performed below the level of the left atrium. Or, as we have stated in our paper (2), "lateral lesions can be biopsied in supine position or from the back in ipsilateral dependent position"

    Best regards, Gernot Rott

    1. Khalid F, Rehman S, AbdulRahman R, Gupta S: Fatal air embolism following local anaesthetisation: does needle size matter? BMJ Case Reports, February 2018, 2018:bcr-2017-222254 2. Rott G, Boecker F: Influenceable and avoidable risk factors for systemic air embolism due to percutaneous ct-guided lung biopsy: patient positioning and coaxial biopsy technique-case report, systematic literature review, and a technical note. Radiol Res Pract 2014;2014:1-8.

    Conflict of Interest:

    None declared

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