A case of intrapulmonary transmission of air while transitioning a patient from a sitting to a supine position after venous air embolism during a craniotomy

Schlundt, Jennifer; Tzanova, Irene; Werner, Christian

doi:10.1007/s12630-012-9680-1

Cited by 12 publications

(8 citation statements)

References 21 publications

(19 reference statements)

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“…Additionally, consequences of VAE such as paradoxical emboli in the presence of patent foramen ovale (PFO) or due to right-to-left intrapulmonary shunting and fatal coagulopathy have been described. 12,17,26,36 Due to the risk of paradoxical emboli, the presence of PFO is considered a contraindication to the sitting position by some, and efforts have been undertaken to identify patients undergoing sitting procedures where there may be a PFO. 9 However, in a series of 200 patients undergoing semisitting procedures, 52 of whom had a PFO, no instances of paradoxical emboli were reported by Feigl et al using modern protocols for VAE detection.…”

Section: Other Neurological and Rare Complicationsmentioning

confidence: 99%

Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position

Himes¹,

Mallory²,

Abcejo

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Historically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series. METHODS The authors reviewed the anesthesia records for instances of clinically significant VAE and other complications for all neurosurgical procedures performed in the sitting position between January 1, 2000, and October 8, 2013. In addition, a prospectively maintained morbidity and mortality log of these procedures was reviewed for instances of subdural or intracerebral hemorrhage, tension pneumocephalus, and quadriplegia. Both overall and specific complication rates were calculated in relation to the specific type of procedure. RESULTS In a series of 1792 procedures, the overall complication rate related to the sitting position was 1.45%, which included clinically significant VAE, tension pneumocephalus, and subdural hemorrhage. The rate of any detected VAE was 4.7%, but the rate of VAE requiring clinical intervention was 1.06%. The risk of clinically significant VAE was highest in patients undergoing suboccipital craniotomy/craniectomy with a rate of 2.7% and an odds ratio (OR) of 2.8 relative to deep brain stimulator cases (95% confidence interval [CI] 1.2-70, p = 0.04). Sitting cervical spine cases had a comparatively lower complication rate of 0.7% and an OR of 0.28 as compared with all cranial procedures (95% CI 0.12-0.67, p < 0.01). Sitting cervical cases were further subdivided into extradural and intradural procedures. The rate of complications in intradural cases was significantly higher (OR 7.3, 95% CI 1.4-39, p = 0.02) than for extradural cases. The risk of VAE in intradural spine procedures did not differ significantly from sitting suboccipital craniotomy/craniectomy cases (OR 0.69, 95% CI 0.09-5.4, p = 0.7). Two cases (0.1%) had to be aborted intraoperatively due to complications. There were no instances of intraoperative deaths, although there was a single death within 30 days of surgery. CONCLUSIONS In this large, modern series of cases performed in the sitting position, the complication rate was low. Suboccipital craniotomy/craniectomy was associated with the highest risk of complications. When appropriately used with modern anesthesia techniques, the sitting position provides a safe means of surgical access.

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Section: Other Neurological and Rare Complicationsmentioning

confidence: 99%

Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position

Himes¹,

Mallory²,

Abcejo

et al. 2017

Journal of Neurosurgery

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“…In surgeries performed while in the sitting position, in order to reveal the possible risks, it is extremely important to eliminate intracardiac shunting with a careful examination before the operation. Without intracardiac shunting, paradoxical air embolism occurs rarely and only a few isolated cases have been reported [7][8][9] . In the first case, trigeminal rhizotomy operation was being performed while the patient was in the sitting position.…”

Section: Discussionmentioning

confidence: 99%

“…It must be emphasized that air embolism has the potential of passing from intrapulmonary arteriovenous anastomoses through the pulmonary capillary bed without being filtered. Development of PAE can be explained by means of two mechanisms: Air embolus either passes through lung capillary bed or through IPAV anastomosis which bypass this capillary bed [7] .…”

Section: Discussionmentioning

confidence: 99%

Paradoxal Air Embolism Occuring During Sitting Position in a Patient Without an Intracardiac Defect

Karaaslan¹,

Öztürk²,

Topuz³

et al. 2015

GKDA Derg

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Sitting position is widely used in neurosurgery. One disadvantage of this position is a negative pressure in cranial veins in the sitting position that leads to air embolism. The most common cause is intracardiac shunting induced by patent foramen ovale, and it can be determined by transesophageal echocardiography (TEE). However, rarely, paradoxical air embolism (PAE) can occur through intrapulmonary functional arteriovenous anastomoses developing during anesthesia. The aim of this paper is to increase awareness about development of PAE which can occur through intrapulmonary shunt aggravated by hypoxia in cases with high incidencerates of VAE (venous air embolism).

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“…37 TEE is the most sensitive invasive method for diagnosing air embolism, 9 in addition to the ability to diagnose paradoxical air embolism. 38 TEE allows for the diagnosis of small air volumes in the heart -between 0.01 and 0.19 mL/kg. 39 In a trial in India with 140 patients undergoing surgery of the posterior fossa, a comparison was made between using ETCO 2 and TEE for the diagnosis of air embolism.…”

Section: Transesophageal Echocardiographymentioning

confidence: 99%

Venous air embolism in neurosurgery

Giraldo

Lopera

Arango

2015

Colombian Journal of Anesthesiology

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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.

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A case of intrapulmonary transmission of air while transitioning a patient from a sitting to a supine position after venous air embolism during a craniotomy

Cited by 12 publications

References 21 publications

Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position

Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position

Paradoxal Air Embolism Occuring During Sitting Position in a Patient Without an Intracardiac Defect

Venous air embolism in neurosurgery

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