INCIDENCE OF VENOUS AIR EMOLISM AND POSTOPERATIVE COMPLICATION IN NEUROSURGERY IN SITTING POSITION (VENOUS AIR EMOLISM IN NEUROSURGERY IN SITTING POSITION)POGOSTOST ZRAČNE EMBOLIJE IN POOPERATIVNI ZAPLETI PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU Skr
Abstract
Background: Posterior fossa surgery and cervical spine surgery are at risk for venous air embolism (VAE) occurrence. Mostly air emboli are small and asymptomatic, but invasion of large quantity of air in the circulation is symptomatic and potentially lethal. Transesophageal echocardiography is the most sensitive method for detection of air emboli in the heart, followed by the precordial Doppler probe, end tidal carbon dioxide monitoring (etCO2) and others.
Methods: In our 14- years retrospective review we evaluated the incidence of VAE and postoperative complications in patients with posterior fossa surgery or cervical spine surgery. VAE was recognized by using Doppler probe and/or drop of etCO2. If VAE occurred, aspiration of air through the CVC was used to prevent or to minimized VAE occurrence, the surgeon was warned about the incident. VAE treatment was supportive.
Results: VAE was recognized in 74 patients. Two patients after head surgery and four patients after neck surgery needed postoperative treatment in intensive care unit and controled mechanical ventilation. In six patients after head surgery and in four patients after neck surgery new neurological symptoms occurred. Two patients after head surgery died due to complications of massive VAE.
Conclusions: VAE is rare, but serious complication of neurosurgery in sitting position. Preventive treatment, early detection of VAE, supportive treatment and treatment of cardiovascular complications are necessary for survival of patients with VAE.Downloads
References
Porter JM, Pidgeon C, Cunningham AJ. The sitting position in neurosurgery: a critical appraisal. Br J Anaesth 1999; 82: 117-28.
Aleksić V, Radulović D, Milaković B, Nagulić M, Vucović D, Antunović V, Djordjević M. A retrospective analysis of anesthesiologic complications in pediatric neurosurgery. Pediatr Anaesth 2009; 19: 879-86.
Adhikary GS, Massey SR. Massive sir embolism: A case report. J Clin Anesth 1998; 10: 70-2.
Papadopoulos G, Kuhly P, Brock M, et al. Venous and paradoxical air embolism in neurosurgycal patients in the sitting posittion: detection by transesophageal echocardiography. Acta Neurochir 1994; 126: 140-3.
Faberowski LW, Black S, Mickle JP. Incidence of venous air embolism during craniotomy for craniosynostosis repair. Anaesthesiology 2000; 92: 20-3.
Ely EW, Wite RD, Baker AM, Johnson MM. Venous air embolism from central venous catheterisation: A need for increased physician awareness’. Crit Care Med 1999; 27: 2113-7.
Ganslandt O, Merkel A, Schmitt H, Tzabazis A, Buchfelder M, Eyupoglu I, Muenster T. The sitting position in neurosurgery: indications, complications and results a single institution experience of 600 cases. Acta Neurochir 2013; 155:1887-93.
Dilmen OK, Akcil EF, Tureci E, Tunali Y, Bahar M, Tanriverdi T, Aydin S, Yentur E. Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases. Turk Neurosurg 2011; 21: 634-40.
Black S, Ockert DB, Oliver WC, Cucchiara RK. Outcome following posterior fossa craniectomy in patients in the sitting or horizontal positions. Anesthesiology 1988; 69: 49–56.
Campkin TV. Posture and ventilation during posterior fossa and cervical operations. Br J Anaesth 1981; 53: 881–3.
Elton RJ, Howell SC. The sitting position in neurosurgical anaesthesia: a survey of British practice in 1991. Br J Anaesth 1994; 73: 247–8.
Martin JT. Neuroanesthetic adjuncts for surgery in the sitting position: I. Introduction and basic equipment. Anesth Analg 1970; 49: 588.
Martin TJ. Neuroanesthetic adjuncts for surgery in the sitting position: III. Intravascular electrocardiography. Anesth Analg 1970; 49: 793–808.
Martin JT. Neuroanesthetic adjuncts for surgery in the sitting position: II. The antigravity suit. Anesth Analg 1979; 49: 588–93.
Mammoto T, Hayashi Y, Ohnishi Y, Kuro M. Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position: Detection by transesophageal echocardiography. Acta Anaesthesiol Scand 1998; 42: 643-7.
Rath GP, Bithal PK, Chaturvedi A, Dash HH. Complications related to positioning in posterior fossa craniectomy. J Clin Neurosci 2007; 14: 520-5.
Capan LM, Miller SM. Monitoring for suspected pulmonary embolism. Anesthesiology Clinics of North America 2001; 19: 673-703.
Israelian LA, Shimanskiĭ VN, Otamanov DA, Poshataev VK, Lubnin AIu. Patient positioning on the operating table in neurosurgery: sitting or lying. Anesteziol Reanimatol 2013; 4:18-26.
Jadik S, Wissing H, Friedrich K, Beck J, Seifert V, Raabe A. A standardized protocol for the prevention of clinically relevant venous air embolism during neurosurgical interventions in the semisitting position. Neurosurgery 2009; 64: 533-9.
Di Lorenzo N, Caruso R, Floris R, Guerrisi V, Bozzao L, Fortuna A. Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study. Acta Neurochir 1986; 83: 112-5.
Hervías A, Valero R, Hurtado P, Gracia I, Perelló L, Tercero FJ, González JJ, Fàbregas N. Detection of venous air embolism and patent foramen ovale in neurosurgery patients in sitting position. Neurocirurgia 2014; 25:108-15.
Harrison EA, Mackersie A, McEwan A, Facer E. The sitting position for neurosurgery in children: a review of 16 years, experience. Br J Anaesth 2002; 88: 12-7.
Chang EF, Cheng JS, Richardson RM, Lee C, Starr PA, Larson PS. Incidence and management of venous air embolisms during awake deep brain stimulation surgery in a large clinical series. Stereotact Funct Neurosurg 2011; 89: 76-82.
Dilmen OK, Akcil EF, Tureci E, Tunali Y, Bahar M, Tanriverdi T, Aydin S, Yentur E. Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases. Turk Neurosurg 2011; 21: 634-40.
Mirski MA, Lele AV, Fitzsimmons L, Toung TJK. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007; 106: 164-77.
Tommasino C, Rizzardi R, Baretta L, Venturino M, Piccoli S. Cerebral ischemia after venous air embolism in the absence of intracardiac septal defects. J Neurosurg Anesthesiol 1996; 8: 30-4.
Tommasino C, Rizzardi R, Beretta L, Venturino M, Piccoli S. Cerebral ischemia after venous air embolism in the absence of intracardiac septal defects. J Neurosurg Anesthesiol 1996; 8: 1-2.
Bedell EA, Berge KH, Losasso TJ. Paradoxic air embolism during venous air embolism: transesophageal echocardigraphic evidence of transpulmonary air passage. Anesthesiology 1994; 80: 947-50.
Tarun K, Guillermo G. Air embolism as a cause of the systemic inflammatory response syndrome: A case report. Crit Care 2003; 7: 98-100.
Lynch JJ, Schuchard GH, Gross CM, Wann LS. Prevalence of right-to-left-atrial shunting in a healthy population: detection by Valsava manoeuvre contrast echocardiography. Am J Cardiol 1984; 53: 1478-80.
VonGosseln HH, Samii M, Suhr D, Bini W. The lounging position for posterior fossa surgery: anesthesiological considerations regarding air embolism. Childs Nerv Syst 1991; 7: 368-74.
Schmitt HJ, Hemmerling TM. Venous air emboli occur during release of positive end-expiratory pressure and repositioning after sitting position surgery. Anesth Analg 2002; 94: 400-3.
Fritz GA. Hair splitting, air embolism, and transesophageal echocardiography. Anesthesiology 2007; 107: 852.
Laban JT, Rasul FT, Brecker SJ, Marsh HT, Martin AJ. Patent foramen ovale closure prior to surgery in the sitting position. Br J Neurosurg 2014; 28: 421-2.
Schlundt J, Tzanova I, Werner C. A case of intrapulmonary transmission of air while transitioning a patient from a sitting to a supine position after venous air embolism during a craniotomy. Can J Anaesth 2012; 59: 478-82.
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