Venous air embolism and the sitting position: A case series

Leslie, Kate; Ren, Hui; Kaye, Andrew H.

doi:10.1016/j.jocn.2005.08.007

Cited by 62 publications

(29 citation statements)

References 12 publications

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“…Based on TEE and information from the operators, we believe that the CO 2 directly entered the venous circulation via the torn RVOT. Previous studies reported venous air embolism that was more common when the patient was in the sitting position during neurosurgical cases [7,8]. Because our patient was in the Trendelenburg position and central venous pressure was 8-12 mmHg during the anastomosis, it seems unlikely that air was aspirated into the venous system.…”

Section: Discussionmentioning

confidence: 75%

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

et al. 2010

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We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism.

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Section: Discussionmentioning

confidence: 75%

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

et al. 2010

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“…Two of its main advantages are an optimal biomechanical condition of intracranial compartments of the patients and an ideal ergonomic position for the surgeons. However, despite several studies confirming its relative safety, the sitting position is burdened by significant complications that, according to some authors, even balance the aforementioned advantages [1][2][3][4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide field flooding reduces the hemodynamic effects of venous air embolism occurring in the sitting position

et al. 2015

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“…The incidence of VAE reported for similar procedures ranges between 1 and 9% with differences due largely to patient positioning and methods of detecting and properly identifying VAE [1][2][3] . In the sitting position, it is postulated that the risk of VAE rises due to an increased negative pressure gradient between the operative site and the right atrium.…”

Section: Introductionmentioning

confidence: 99%

“…In the sitting position, it is postulated that the risk of VAE rises due to an increased negative pressure gradient between the operative site and the right atrium. This pressure gradient is further enhanced in awake patients who are spontaneously breathing, due to the negative intrathoracic pressure generated with each breath during the inspiratory phase [1] .…”

Section: Introductionmentioning

confidence: 99%

Incidence and Management of Venous Air Embolisms during Awake Deep Brain Stimulation Surgery in a Large Clinical Series

Chang

Cheng

Richardson

et al. 2011

Stereotact Funct Neurosurg

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Background/Aims: Venous air embolism (VAE) is a potential complication during neurosurgical procedures, particularly in the sitting position. The diagnosis and management of VAE in patients undergoing awake deep brain stimulation (DBS) lead implantation in the sitting position are underreported. Methods: We performed a retrospective chart review of 467 consecutive DBS surgeries at the University of California, San Francisco. Data was collected for patient demographics, diagnosis, intraoperative events, and postoperative course. Results: Six cases of clinically diagnosed VAE were found, amounting to a total incidence of 1.3% per procedure. We did not observe a statistical association with patient age, diagnosis, or DBS target. The most common symptoms of intraoperative VAE were coughing, oxygen desaturation, and hypotension. In all cases, VAE was treated by copious irrigation of the surgical field and lowering the patient’s head. In 4 cases, DBS implantation was abandoned because of ongoing symptoms of VAE. The respiratory outcome in all patients was good after several days of close observation. Conclusion: The incidence of VAE during DBS procedures is small, but prompt recognition and management of VAE are critical to avoid further associated complications.

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Venous air embolism and the sitting position: A case series

Cited by 62 publications

References 12 publications

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting

Carbon dioxide field flooding reduces the hemodynamic effects of venous air embolism occurring in the sitting position

Incidence and Management of Venous Air Embolisms during Awake Deep Brain Stimulation Surgery in a Large Clinical Series

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