Venous Air Embolism during Deep Brain Stimulation Surgery in an Awake Supine Patient

Deogaonkar, Anupa; Avitsian, Rafi; Henderson, Jaimie M.; Schubert, Armin

doi:10.1159/000085024

Cited by 36 publications

(21 citation statements)

References 21 publications

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“…The procedure is commonly performed in awake, spontaneous ventilating patients. Intraoperative complications include hemorrhage, seizures, and venous air embolism (VAE) [3,5,6] . This risk of VAE during surgery is increased when the head is in an elevated position and when positive pressure ventilation is not utilized [6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…This risk of VAE during surgery is increased when the head is in an elevated position and when positive pressure ventilation is not utilized [6][7][8][9] . During awake stereotactic DBS and lesion surgeries, VAE has been reported, and has been associated with the clinical manifestation of a cough [5,6,[10][11][12] . VAE may lead to serious consequences such as pulmonary edema, respiratory failure, and even death [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

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Venous Air Embolism in Deep Brain Stimulation

Hooper

Okun

Foote³

et al. 2008

Stereotact Funct Neurosurg

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Background/Aims: During the placement of electrodes for deep brain stimulation (DBS), patients are commonly in a seated position, awake, and spontaneously breathing. Air may be entrained through bone or dural veins causing venous air emboli (VAE) and this phenomenon can result in significant hemodynamic changes. Although VAEs have been described in many types of neurosurgical procedures, their incidence during DBS surgery is unknown. Methods: Following approval from the Institutional Review Board, the University of Florida Movement Disorders Center database comprising 286 DBS leads placed since 2002 was reviewed. Intraoperative cough, which has been associated with VAE, as well as hemodynamic instability were the focus of the review. Additionally, a prospective evaluation of the incidence of VAE using precordial Doppler ultrasound was undertaken over a 3-month period (June 2007–August 2007). Results: The retrospective review revealed a 3.2% incidence of cough per lead. Prospective monitoring in 21 consecutive patients with 22 leads yielded the detection of 1 VAE, and an incidence of 4.5% per lead. Conclusion: VAEs are rare but potentially serious complications of DBS surgery unless recognized. Patient positioning and the occurrence of cough are two important predictors to consider in VAE. Precordial Doppler is a safe, non-invasive monitor that can be used in the early detection of VAE in these procedures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Venous Air Embolism in Deep Brain Stimulation

Hooper

Okun

Foote³

et al. 2008

Stereotact Funct Neurosurg

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“…However, the detection of VAE may be further delayed in patients undergoing awake procedures because VAE presentation is more atypical if it is compared with the more classical features of VAE in patients who are under general anaesthesia. 5,6 The severity of clinical presentation is determined by the volume of air, as well as the rate of air entrainment. An acute amount of air of more than 2 ml/kg is more likely to cause chest pain, right heart failure and cardiovascular collapse.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 There have been a few reported cases of VAE in DBS surgery that raise a concern for extra monitoring and prompt management of this situation. [4][5][6] All previous reported cases occurred during the burr hole and insertion of the electrodes on only one side of the procedure. However, in our case the suspicious symptoms occurred repeatedly during both sides of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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

Hassan

Yeap

Mukmin

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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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.

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“…Complications may still occur during awake DBS procedures. Deoganokar reported a cas e of venous a ir embolism i n an elderly PD patient wi th a myocardial infarction [68]. Glossop and Dobbs also report two cases of coronary artery vasospasm during electrode implantation.…”

Section: The Role Of Anesthesiologist In Dbs Surgerymentioning

confidence: 96%