Venous air embolism in neurosurgery

Abstract

AnesthesiaCerebral veins a b s t r a c t Venous air embolism is a potentially serious neurosurgical complication. Every neurosurgical procedure is at risk of developing the condition but the sitting and semi-sitting position represent a higher risk. The neuroanesthesiologist plays a key role in the management of the venous air embolism, from diagnosis to treatment. This article reviews the literature on air embolism in terms of its incidence, etiology, diagnosis and therapy. Embolismo aéreo venoso en neurocirugíaPalabras clave: Neurocirugía Procedimientos Neuroquirúrgicos Embolia Aérea Anestesia Venas Cerebral r e s u m e n El embolismo aéreo venoso es una complicacion de neurocirugia que puede llegar a ser potencialmente seria. Todos los procedimientos neuroquirurgicos tienen riesgo de presentarlo, siendo las posiciones sentada y semisentada las que mayor riesgo conllevan.El neuroanestesiologo forma parte primordial en el manejo del embolismo aéreo venoso, desde su diagnostico hasta el tratamiento. Este articulo revisa la literatura relacionada conel embolismo aéreo en cuanto a incidencia, etiologia, diagnostico y terapéutica.

Potentially avoidable issues in neurosurgical mortality cases in Australia: identification and improvements

“…One example involved an air embolism, the assessor noting that the risk in a patient with a significantly elevated head during surgery was underestimated, with no measures to detect or treat the embolism. Air embolism during neurosurgery is recognized as a serious complication, with experienced anaesthetist care a key requirement for treatment . In another case, the assessor expressed concern that there was no anaesthetic consultant (only a junior anaesthetist) in the operating theatre at the start of the operation, a time ‘ when the most important anaesthetic events occur ’.…”

“…Air embolism during neurosurgery is recognized as a serious complication, with experienced anaesthetist care a key requirement for treatment. 10 In another case, the assessor expressed concern that there was no anaesthetic consultant (only a junior anaesthetist) in the operating theatre at the start of the operation, a time 'when the most important anaesthetic events occur'.…”

Sitting Position in Neurosurgery

“…However, it is a subjective, nonquantitative method, and the anesthesiologist needs to be familiar with it use. 21 TEE has the advantage of making a precise diagnosis and is very sensitive. TEE allows for the detection of small air volumes in the heart, even 0.01 mL/kg of air.…”

“…If the embolism is large (> 5 mL/kg), a gas airlock scenario can lead to right-sided heart failure and immediate cardiovascular collapse. 21 The true incidence of VAE depends on the method of detection used. Ganslandt et al in 2013 in their study of 600 cases had an overall 19% incidence of VAE.…”

“…If VAE is suspected either by fall in ETCO 2 or microbubbles on TEE, the neurosurgeon is immediately informed and the surgical field should be irrigated or covered with saline soaked swabs, ventilated with 100% oxygen and intravenous fluids, and, if necessary, vasopressors started to support the circulation. 21,37,40 Transient bilateral compression of the jugular veins is a technique described to reduce the inflow of air through the exposed sinuses, as well as identify the source of air entrainment. In neurosurgical procedures performed in the sitting position, when VAE occurs, transient manual jugular venous compression limits further air entry into the circulation.…”