Temporal insular glioma–rare case report for a venous air embolism

Abstract

Background Venous air embolism (VAE) is a well-known entity in the field of neuroanesthesia, with established surgeries and positions where its occurrence is high. The insular cortex is a deep area within the lateral sulcus, and surgeries in this area are not reported to develop VAE. Case presentation A young male being operated on the insular cortex developed VAE, had cardiac arrest, was revived, and was extubated with no residual deficit due to the untoward event. Conclusions An anesthesiologist should always be prepared for this complication due to its rapid presentation and fatal consequences.

Paradoxical venous air embolism detected with point-of-care ultrasound: a case report

“…Once VAE diagnosis is made, definitive therapy can be considered, especially if the patient is hemodynamically unstable or complicated by end-organ damage [ 5 ]. In case of hemodynamic instability, some studies have suggested that removing the air emboli from the right ventricle outflow tract, and hence maintaining circulation, can be made by increasing central venous pressures with intravenous fluids and patient positioning in Durant’s position (head low and right up) [ 1 ]. However, the ideal position assumed by an affected patient remains controversial as recent animal studies have demonstrated a lack of improvement despite relocating air bubbles to the apex of the right ventricle by means of postural changes [ 5 ].…”

“…However, the ideal position assumed by an affected patient remains controversial as recent animal studies have demonstrated a lack of improvement despite relocating air bubbles to the apex of the right ventricle by means of postural changes [ 5 ]. Another strategy might be intermittent jugular venous compression, in order to prevent further air entry [ 1 ].…”

“…Hemodynamically unstable patients and those with end-organ damage or neurological deficits should be treated with definitive therapy such as hyperbaric oxygen, which may be delivered after a significant delay and still provides benefit [ 2 , 3 ]. However, if this therapy is unavailable, aspiration of air directly from the circulation using intracardiac catheter aspiration with a multiple side-hole catheter such as a 5-French pigtail catheter or even direct aspiration with the tip of a previously positioned CVC approximately 1–3 cm above the sinoatrial node, may be a useful and safe treatment [ 1 – 3 ].…”

“…Venous air embolism is the entrainment of air from any communication between the environment and the venous vasculature [ 1 ]. It is an uncommon entity but it may cause systemic effects and even significant morbidity and mortality depending on the amount of volume embolized [ 2 , 3 ].…”

“…Other lower volumes may be related to a variety of signs and symptoms ranging from dyspnea, wheezing, and coughing to chest pain in awake patients. In those patients who are anesthetized, these symptoms would be subtle and therefore the physician must be aware of changes like a steep drop in the end tidal carbon dioxide (etCO 2 ), arterial oxygen saturation (SO 2 ), blood pressure (BP), heart rate (HR), or variations in ST segment and T wave in ECG [ 1 , 7 ].…”