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

Abstract

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).