Fatal venous air embolism during lumbar surgery: the tip of an iceberg?

Development of Cerebral Air Emboli During Mohs Micrographic Surgery

“…Venous entry of gas may occur when noncollapsing veins are incised or when the pressure in incised veins is lower than that of the surrounding atmospheric pressure, creating a pressure gradient favorable to the ingress of ambient air 1 . It has been estimated that the gravitational gradient between the operative site and the right atrium required for the entry of air into the venous system may be as little as 5 cm 3 . Thus, any surgical position other than perfectly supine or prone may place patients at risk for the development of air emboli if noncollapsing veins are incised.…”

“…1 It has been estimated that the gravitational gradient between the operative site and the right atrium required for the entry of air into the venous system may be as little as 5 cm. 3 Thus, any surgical position other than perfectly supine or prone may place patients at risk for the development of air emboli if noncollapsing veins are incised. Seated positions contribute to lower hydrostatic pressures in relevant venous structures superior to the heart.…”

Cardiac arrest after induction of anesthesia in neurosurgical patients

“…Классической ситуацией развития ВВЭ являются нейрохирургиче-ские вмешательства на структурах ЗЧЯ или затылоч-ных долях мозга, выполняемые в положении боль-ного сидя [17][18][19][20], хотя в литературе есть серия пу-бликаций, в которых описано развитие массивной и даже фатальной ВВЭ при спинальных нейрохирур-гических вмешательствах, выполняемых в положе-нии лежа [21][22][23]. Действительно, острая массив-ная ВВЭ может привести к асистолии, но для ее раз-вития необходимо повреждение крупных венозных коллекторов с ригидными стенками, которые пре-пятствуют их спадению при негативном давлении в них (типа синусов мозга), и наличие градиента дав-ления, приводящего к засасыванию воздуха в веноз-ный коллектор, что никак не совпадает с нашей си-туацией.…”

Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant

“…Similar phenomena leading to fatal outcomes have been reported during lumbar laminectomy in older patients. 7,8 There are two possible sources of nitrogen during laparoscopy: direct entry of room air through a lacerated extraperitoneal vessel and residual air within the endoscopic tubing entering the peritoneum during insufflation and potentially entering the circulation through a bleeding vessel anytime throughout the procedure. The tubing currently in use in our institution for laparoscopy has a volume of 230 mL.…”