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Fatal air embolism during dental implant surgery: a report of three cases

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Between October 6, 1986 and September 17, 1987, 11 patients underwent insertion of mandibular dental prostheses by the same oral surgeon. Three patients suffered cardiac arrest during surgery and subsequently died. Two of the patients who died had received general anaesthetics and the other had intravenous sedation given by three different anaesthetists. All three patients arrested suddenly, developing profound cyanosis and electrical mechanical dissociation, underwent prolonged resuscitative efforts, and had marked hypoxaemia and hypercapnia, despite cardiopulmonary resuscitation. Two other patients had signs of injection of air but survived, one suffering cardiac collapse and the other sustaining massive subcutaneous emphysema. Air embolism was produced by inadvertent injection of a mixture of air and water, passing through the hollow dental drill, directly into the mandible to the facial and pterygoid plexus veins and thence to the superior vena cava and right atrium.

Résumé

Du 6 octobre 1986 au 17 septembre 1987, le mme chirurgien-dentiste procéda à l’insertion intramandibulaire de prothèses chez 11 patients. Trois d’entre eux succombèrent à un arrêt cardiaque pendant l’intervention. Trois anesthésistes différents avaient utilisé dans deux cas, une anesthésie génerale et dans l’autre, de la sédation par voie intraveineuse. La dissociation électromécanique doublée de cyanose survenait brutalement et demeurait réfractaire aux efforts prolongés de réanimation avec hypoxémie et hypercarbie marqués. Une emphysème souscutané spectaculaire chez l’un et un épisode de collapsus cardiovasculaire chez l’autre, fit suspecter une injection d’air chez deux survivants. Il s’avéra qu’un mélange accidentel d’air et d’eau irriguant la fraise dentaire se trouvait injecté directement dans le maxillaire inférieur, et de là, par les plexus veineux faciaux et ptérygoïdiens allait jusqu’ à la veine cave et à l’oreillette droite, créant une embolie aérienne massive.

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Authors and Affiliations

  1. Department of Anaesthesia, Foothills Hospital at the University of Calgary, 1403 - 29th St. N.W., Calgary, Calgary, Alberta, Canada

    J. M. Davies

  2. Medical Investigations, Office of the Chief Coroner of British Columbia, Burnaby, British Columbia, Canada

    Linda A. Campbell

Authors
  1. J. M. Davies
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  2. Linda A. Campbell
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Davies, J.M., Campbell, L.A. Fatal air embolism during dental implant surgery: a report of three cases. Can J Anesth 37, 112–121 (1990). https://doi.org/10.1007/BF03007491

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