Acute management of vascular air embolism

Abstract

Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers.

Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position

“…В этих случаях, согласно концепции открытых легких, проводится респираторная под-держка, включающая проведение рекрутмент-ма-невра и использование адекватного уровня ПДКВ. При наличии открытого овального окна или вну-трилегочного шунтирования, приведшего к ПВЭ, может развиться полиорганная недостаточность, требующая соответствующего подхода и интенсив-ной терапии [22]. Повреждение головного мозга при ПВЭ обусловливает необходимость проведения нейропротекции.…”

Management of Inadvertent Injury to Superior Sagittal Sinus in Parasagittal Meningioma: Technical Note

“…The reported mortality and morbidity had reached 10% and 12.3%, respectively, in situations where venous reconstruction had not been performed [13]. Nowadays, numerous surgical techniques have been implemented in reconstructing the venous sinuses with good clinical outcome [14][15][16][17][18][19]. A graft is usually applied over the preached sinus.…”

Venous Air Embolism (VAE) during craniotomy of supratentorial meningioma in supine position

“…7 Therefore other invasive monitoring such as arterial line, CVC, and end tidal CO 2 were used in addition to the standard monitoring.…”