Urgent Repositioning After Venous Air Embolism During Intracranial Surgery in the Seated Position: A Case Series

Journal of Neurosurgical Anesthesiology
Arnoley S AbcejoWilliam J Perkins

Abstract

Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. Patients undergoing a neurosurgical procedure in the seated position at a single institution between January 2000 and October 2013 were identified. Corresponding medical records, neurosurgical operative reports, and computerized anesthetic records were searched for intraoperative VAE diagnosis. Extreme VAE was defined as a case in which urgent seated to level position change was performed for patient safety. Detailed examples of extreme VAE cases are described, including their intraoperative course, VAE management, and postoperative outcomes. There were 8 extreme VAE (0.47% incidence), 6 during suboccipital craniotomy (1.5%) and 2 during deep brain stimulator implantation (0.6%). VAE-associated end-expired CO2 and mean arterial pressure reductions rapidly normalized following position change. No new neurological deficits or cardiac events associate...Continue Reading

References

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Citations

Jan 24, 2020·Journal of Neurosurgical Anesthesiology·Jeffrey J Pasternak
Nov 24, 2020·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Xu WangYuhai Bao
Jul 4, 2020·Journal of Neurosurgery. Spine·Benjamin T HimesMohamad Bydon

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