A Standardized Protocol for the Prevention of Clinically Relevant Venous Air Embolism During Neurosurgical Interventions in the Semisitting Position

Abstract

Fear of massive venous air embolism is one reason for dramatic decline in the use of the semisitting position in neurosurgical practice. We found that strict adherence to a standardized protocol using TEE monitoring before and during surgery; exclusion of patients with patent foramen ovale; and a combination of positive end expiratory pressure, fluid input, and a standardized position aiming a positive pressure in the transverse and sigmoid sinuses helped to greatly minimize this complication to a rate of 0.5% for hemodynamically relevant events.

The paramedian supracerebellar-transtentorial approach to the entire length of the mediobasal temporal region: an anatomical and clinical study

“…For example, the semisitting position needs special attention from the neurosurgeon, anesthesiologist, nurses, technicians, and the entire operating team. 14,21,62 However, modern neuroanesthesiology with TEE and modern monitoring methods have made this position safe. It is important to mention that the absence of any septal defect must be confirmed with TEE through the bubble test, as transthoracic echocardiography may miss small defects.…”

Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position

“…Так, считается, что снижает риск возникновения ВВЭ проведение оперативного вмешательства в положении полусидя с приподнятым ножным концом операционного стола по методу S. Jadik и соавт. [29]. В этой позиции тазобедренные суста-вы согнуты максимально до 90°, ноги подняты кверху таким образом, что стопы пациента нахо-дятся выше его головы.…”

Feasibility of Intraoperative MRI Guidance for Craniotomy and Tumor Resection in the Semisitting Position

“…25 Adherence to specific protocols to prevent air embolism in the semisitting position has enabled frequent use of this positioning technique without major morbidity. 14,26 The ability to perform iMRI-guided surgeries in the semisitting position might be of advantage in selected patients.…”

“…11,14 In short, patients were positioned with their head and feet lifted, with a hip flexion of 90 degrees, and knee flexion of around 30 degrees, to maximize venous flow and to achieve a positive venous pressure at the site of surgery. It is crucial to have the feet at least at the level of the head, preferably higher.…”