scholarly journals A case report of anaesthesia for craniotomy in sitting position

2021 ◽  
Vol 8 (4) ◽  
pp. 611-614
Author(s):  
Dinesh Suryanarayana Rao ◽  
Veena Velmurugan
Keyword(s):  
Case Report ◽  
High Risk ◽  
Air Embolism ◽  
Hemodynamic Instability ◽  
Anaesthetic Management ◽  
Sitting Position ◽  
Venous Air Embolism ◽  
Long Duration ◽  
Exact Position ◽  
Space Occupying Lesion

Tumors in the posterior fossa can be done in lateral, supine, prone, sitting and in park bench positions. Depending on the exact position of the lesion and the technical preference of the surgeon, sitting position may be preferred. Sitting position grants best possible access to deeper structures with minimal retraction. However, maintenance of anaesthesia in this position for long duration pose some serious challenges to the anaesthesiologist including high risk of venous air embolism (VAE), hemodynamic instability and respiratory disturbances. Here, we present a case report of a 36year old male diagnosed with pineal gland space occupying lesion (SOL), operated in the sitting position under general anaesthesia. We discuss about anaesthetic management and possible complications that can be encountered.

Massive venous air embolism in the semi-sitting position during surgery for a cervical spinal cord tumor: anatomic and surgical pitfalls

2009 ◽  
Vol 16 (7) ◽  
pp. 972-975 ◽  
Author(s):  
Luca Basaldella ◽  
Valentina Ortolani ◽  
Ulisse Corbanese ◽  
Carlo Sorbara ◽  
Pierluigi Longatti
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spinal Cord Tumor ◽  
Air Embolism ◽  
Sitting Position ◽  
Venous Air Embolism

Neurosurgery

2018 ◽  
Author(s):  
Alex Manara ◽  
Samantha Shinde
Keyword(s):  
Air Embolism ◽  
Pituitary Surgery ◽  
Anaesthetic Management ◽  
Beating Heart ◽  
Vascular Lesions ◽  
Posterior Fossa Surgery ◽  
Intracranial Haematoma ◽  
Venous Air Embolism ◽  
Heart Donor

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.

Effects of positive end-expiratory pressure ventilation on cerebral venous pressure with head elevation in dogs

2000 ◽  
Vol 88 (2) ◽  
pp. 655-661 ◽  
Author(s):  
Thomas J. K. Toung ◽  
H. Aizawa ◽  
Richard J. Traystman
Keyword(s):  
Prone Position ◽  
Venous Pressure ◽  
Air Embolism ◽  
Right Atrial ◽  
Sitting Position ◽  
Positive End Expiratory Pressure ◽  
Jugular Veins ◽  
Venous Air Embolism ◽  
Head Elevation ◽  
Cerebral Venous Pressure

Mechanical ventilation with positive end-expiratory pressure (PEEP) may prevent venous air embolism in the sitting position because cerebral venous pressure (Pcev) could be increased by the PEEP-induced increase in right atrial pressure (Pra). Whereas it is clear that there is a linear transmission of the PEEP-induced increase in Pra to Pcev while the dog is in the prone position, the mechanism of the transmission with the dog in the head-elevated position is unclear. We tested the hypothesis that a Starling resistor-type mechanism exists in the jugular veins when the head is elevated. In one group of dogs, increasing PEEP linearly increased Pcev with the dog in the prone position (head at heart level, slope = 0.851) but did not increase Pcev when the head was elevated. In another group of dogs, an external chest binder was used to produce a larger PEEP-induced increase in Pra. Further increasing Pra increased Pcev only after Pra exceeded a pressure of 19 mmHg (break pressure). This sharp inflection in the upstream (Pcev)-downstream (Pra) relationship suggests that this may be caused by a Starling resistor-type mechanism. We conclude that jugular venous collapse serves as a significant resistance in the transmission of Pra to Pcev in the head-elevated position.

scholarly journals Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach

2005 ◽  
Vol 33 (3) ◽  
pp. 323-331 ◽  
Author(s):  
C. M. Domaingue
Keyword(s):  
Superior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Air Embolism ◽  
Transoesophageal Echocardiography ◽  
Systemic Circulation ◽  
Right Atrial ◽  
Sitting Position ◽  
Volume Loading ◽  
Venous Air Embolism

Neurosurgery in the sitting position offers advantages for certain operations. However, the approach is associated with potential complications, in particular venous air embolism. As the venous pressure at wound level is usually negative, air can be entrained. This air may follow any of four pathways. Most commonly it passes through the right heart into the pulmonary circulation, diffuses through the alveolar-capillary membrane and appears in expelled gas. It may pass through a pulmonary-systemic shunt such as a probe patent foramen ovale (paradoxical air embolism); it may collect at the superior vena cava-right atrial junction. Rarely it may traverse through lung capillaries into the systemic circulation. Many monitors, such as the precordial Doppler, capnography, pulmonary artery catheter, transoesophageal echocardiography are useful for venous air embolism detection, with transoesophageal echocardiography being today's gold standard. Various manoeuvres, including neck compression and volume loading, are also useful in reducing the incidence of venous air embolism. Volume loading, in particular, is very helpful as it reduces the risk of hypotension. Other particular concerns to the anaesthetist are airway management, avoidance of pressure injuries, and the risk of pneumocephalus, oral trauma, and quadriplegia. Newer anaesthetic agents have made the choice of anaesthetic technique easier. An appreciation of the implications of neurosurgery in the sitting position can make the procedure safer.

Incidence of Venous Air Embolism during Craniectomy for Craniosynostosis Repair

2000 ◽  
Vol 92 (1) ◽  
pp. 20-20 ◽  
Author(s):  
Lisa W. Faberowski ◽  
Susan Black ◽  
J. Parker Mickle
Keyword(s):  
Air Embolism ◽  
Hemodynamic Instability ◽  
Mortality Rates ◽  
Cardiovascular Collapse ◽  
Ultrasonic Probe ◽  
Safe Method ◽  
Venous Air Embolism ◽  
Doppler Probe ◽  
Initiation Of Therapy ◽  
A Prospective Study

Background Investigations to determine the incidence of venous air embolism in children undergoing craniectomy for craniosynostosis repair have been limited, although venous air embolism has been suspected as the cause of hemodynamic instability and sometimes death. A precordial Doppler ultrasonic probe is an accepted method for detection of venous air embolism and is readily available at most institutions. Methods A prospective study was conducted using a precordial Doppler ultrasonic probe in children undergoing craniectomy for craniosynostosis repair. The Doppler signal was continuously monitored intraoperatively for characteristic changes of venous air embolism. A recording was made of the precordial Doppler probe pulses, which was later reviewed by a neuroanesthesiologist, blinded to the intraoperative events. This information was correlated with the intraoperative events and episodes of venous air embolism were graded. Results Twenty-three patients were enrolled in the study during the 2-yr study period. Nineteen patients (82.6%) demonstrated 64 episodes of venous air embolism; six patients (31.6%) had hypotension associated with venous air embolism. Thirty-two episodes of hypotension were demonstrated in eight patients (34.7%). None of the patients developed cardiovascular collapse. Conclusion The incidence of venous air embolism in our study of 23 children undergoing craniectomy for craniosynostosis was 82.6%. Though most episodes of venous air embolism during craniosynostosis repair are without hemodynamic consequences, the preemptive placement of a precordial Doppler ultrasonic probe is a noninvasive, economic, and safe method for the detection of venous air embolism. Prompt recognition may allow for the early initiation of therapy, thereby decreasing morbidity and mortality rates related to venous air embolism.

Venous air embolism from Tisseel use during endoscopic cranial vault remodeling for craniosynostosis repair: a case report

2013 ◽  
Vol 23 (8) ◽  
pp. 754-756 ◽  
Author(s):  
Gohalem G. Felema ◽  
Robert B. Bryskin ◽  
Ian M. Heger ◽  
Roy Saswata
Keyword(s):  
Case Report ◽  
Air Embolism ◽  
Cranial Vault ◽  
Venous Air Embolism ◽  
Cranial Vault Remodeling
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