An unusual case of repeated venous air embolism during awake bilateral deep brain stimulation surgery

Abstract

Venous air embolism (VAE) is the entrainment of air either from a surgical site or from the environment into the venous or arterial vasculature, which can subsequently cause systemic effects. Many cases are subclinical but large volume and high rate of accumulation of air entrainment are potentially life-threatening. The relative risk is high in sitting position craniotomy and posterior fossa surgery but low in burr hole neurosurgery such as in deep brain stimulation (DBS) surgery. The authors report their experience of managing an unusual case of repeated VAE during both sides of burr-hole and electrode insertion in awake bilateral DBS surgery.

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

“…Thus, air can easily entrain via the open diploic veins into the systemic circulation to cause massive cardiopulmonary collapse. Air can be aspirated from the CVC at the neck as part of the management to decompress the right ventricle in patients with VAE 13. Hyperthermia of more than 37.5°C is avoided as it will increase cerebral metabolic rate of oxygen consumption.…”

Perianaesthetic management on a child with Lennox-Gastaut Syndrome for vagus nerve stimulation (VNS) placement

“…As the patient’s neck is slightly higher than the heart and rotates laterally, any surgical trauma to the vessels may cause a fatal venous air embolism (VAE). Thus, early recognition of signs of VAE, such as the abrupt disappearance of end-tidal carbon dioxide and hypotension, is crucial 19–21. Treatment includes fluid resuscitation and vasopressors while the surgeon prevents further air entrainment by bathing the surgical sites with fluids and closure.…”

Awake craniotomy for clipping of unruptured aneurysm: anesthesia concerns, management and challenges

“…The risk of VAE is one of the known complications during awake craniotomy, and cough symptoms are one of its earlier symptoms. 11 Post-operative analgesia was managed with acetaminophen, fentanyl infusions and parecoxib 40 mg every 12 h for two days with patient-controlled analgesia (PCA). Fentanyl as a backup can also be an option.…”