Intraoperative venous air embolism in the non-cardiac surgery-the role of perioperative echocardiography in a case series report

Abstract

Venous air embolism (VAE) is commonly one of the iatrogenic complications associated with divergent high-risk surgeries. In this case-series report, we presented a series of VAE cases in our institute during the last 6 consecutive years. There were total of nine cases suspected to be VAE according the clinical symptom and signs, of which seven cases were definitively diagnosed VAE using transthoracic echocardiography (TTE). We also reported two presumptive cases of paradoxical VAE during hepatectomy in this case series, furthermore, the cause, complications and hazards secondary to paradoxical VAE were discussed as well. All cases had an uneventful recovery from VAE with the assistance of TTE as well as other therapeutic management of VAE, except one neurosurgical patient died from postoperative hemorrhagic stroke per se. Therefore, VAE or paradoxical air embolism can occur during various non-cardiac operations and the significance of perioperative ultrasound should be emphasized in the treatment of VAE.

Pineal region tumours in the sitting position: how I do it

“…Indications of potential VAE include hypotension, sudden drop in ETCO 2 with no change in ventilation settings or drop in oxygen saturations depending on FiO 2 . The neurosurgeon is alerted while the Sudden decrease in EtCO2 by≥2 mmHg [8] Increase in PaCO2 [8] Difference between EtCO2 and PaCO2>10 mmHg [6] Increase in EtN2>0.04% [8] Hypoxia [8] Moderate 0.5-2.0 mL/kg Jugular venous distension [8,9] Unexplained hypotension [8,9] Hypoxia [8,9] ECG: tachyarrhythmias [8], right heart strain pattern (peaked P wave, RBBB, right axis deviation) [9,10] or acute ischaemia ST changes [8][9][10] Cerebral ischaemia (changes in mental status postoperatively) [8,10] Pulmonary hypertension detected via pulmonary artery catheter [6] Pulmonary oedema [9,10] Large>2.0 mL/kg 'Water-wheel' or 'mill-wheel' murmur [8,10] Acute-onset right-sided heart failure [8,9] Cardiovascular collapse [8,9] Cardiac arrest [9] Fatal at 3-4 mL/kg [8,10]…”