scholarly journals Effect of the degree of head elevation on the incidence and severity of venous air embolism in cranial neurosurgical procedures in the semi-sitting position

2017 ◽  
Author(s):  
Hatice Ture
Keyword(s):  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Sitting Position ◽  
Venous Air Embolism ◽  
Head Elevation

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 Intraoperative oxygen embolus and tension pneumocephalus: Is hydrogen peroxide the culprit?

2017 ◽  
Vol 04 (02) ◽  
pp. 114-116
Author(s):  
Supriya Dsouza ◽  
Anil Parakh ◽  
Chitra Sarma ◽  
Adarsh Kulkarni ◽  
Ajit Baviskar
Keyword(s):  
Hydrogen Peroxide ◽  
Supine Position ◽  
Air Embolism ◽  
Neurological Complications ◽  
Neurosurgical Procedures ◽  
Sitting Position ◽  
Tension Pneumocephalus ◽  
Venous Air Embolism ◽  
Intracranial Surgery

AbstractHydrogen peroxide (H2O2) irrigation is commonly utilised in neurosurgical and non-neurosurgical procedures for its bactericidal and haemostatic effects. Tension pneumocephalus and venous air embolism are potentially disastrous neurological complications mostly seen after intracranial surgery in sitting position and trauma. We present a case of oxygen embolus and tension pneumocephalus after H2O2 irrigation during craniotomy in supine position.

Transcranial Doppler Ultrasonography as a Screening Technique for Detection of a Patent Foramen Ovale before Surgery in the Sitting Position

2000 ◽  
Vol 93 (4) ◽  
pp. 971-975 ◽  
Author(s):  
Ruediger Stendel ◽  
Hans-Joachim Gramm ◽  
Klaus Schröder ◽  
Conny Lober ◽  
Mario Brock
Keyword(s):  
Patent Foramen Ovale ◽  
Doppler Ultrasonography ◽  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Sitting Position ◽  
Preoperative Screening ◽  
Reference Standard ◽  
Foramen Ovale ◽  
Venous Air Embolism ◽  
Contrast Enhanced

Background Venous air embolism has been reported to occur in 23-45% of patients undergoing neurosurgical procedures in the sitting position. If venous air embolism occurs, a patent foramen ovale (PFO) is a risk factor for paradoxical air embolism and its sequelae. Preoperative screening for a PFO is therefore recommended by some investigators. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (c-TEE). Contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) are noninvasive alternative methods, but so far there are no studies as to their diagnostic validity in neurosurgical patients. Methods The sensitivity and specificity of c-TCD and c-TTE in detecting a PFO were determined in a prospective study using c-TEE as the reference standard. Preoperative c-TCD, c-TTE, and c-TEE studies were performed during the Valsalva maneuver after intravenous echo-contrast medium (D-Galactose, Echovist-300, Schering AG, Berlin, Germany) was administered in 92 consecutive candidates (47 men and 45 women; mean age, 51 yr; range, 25-72 yr) before neurosurgical procedures in the sitting position. Results A PFO was detected in 24 of the 92 patients (26.0%) using c-TEE. c-TCD correctly identified 22 patients, whereas c-TTE only correctly identified 10. This corresponds to a sensitivity of 0.92 for c-TCD and 0.42 for c-TTE. The negative predictive value was 0.97 for c-TCD compared with 0.83 for c-TTE. The prevalence of a PFO in patients with a posterior fossa lesion was 27%, and in the group with cervical disc herniation was 24% as detected by c-TEE. The incidence of intraoperative venous air embolism was 35% in cases of cervical foraminotomy and 75% in posterior fossa surgery as detected by c-TEE. Conclusions c-TCD is a highly sensitive and highly specific method for detecting a PFO. Because c-TCD is noninvasive, it may be more suitable than c-TEE for routine preoperative screening for a PFO. C-TTE is not reliable in detecting a PFO.

scholarly journals Occurrence and Severity of Venous Air Embolism During Neurosurgical Procedures in Semi-Sitting Versus Supine Position

2021 ◽  
Author(s):  
Franziska Magdalena Konrad ◽  
Angela S Mayer ◽  
Lina Maria Serna-Higuita ◽  
Helene Hurth ◽  
Marcos Tatagiba ◽  
...  
Keyword(s):  
Supine Position ◽  
Air Embolism ◽  
Central Venous Line ◽  
Neurosurgical Procedures ◽  
Sitting Position ◽  
Venous Air Embolism ◽  
Standardized Protocol ◽  
Single Center Study ◽  
Cranial Fossa ◽  
A Prospective Study

Abstract Background: Patients undergoing neurosurgical procedures in the posterior cranial fossa can be placed in different positions: the semi-sitting position or the supine position. The major risk of the semi-sitting positioning is venous air embolism (VAE). However, VAEs may also occur in the supine position.Objective: In a prospective study, we investigated the incidence of VAE based on the positioning of the patients (trial registration 553/2013BO1).Methods: In a single-center study with 137 patients, we prospectively evaluated the occurrence of VAEs in patients in the supine and semi-sitting position over the period from January 2014 to April 2015. All patients were monitored for VAE by the use of a transesophageal echocardiography (TEE).Results: 50% of all participating patients experienced a VAE (with 56% of these patients undergoing surgery in the semi-sitting position and 11% in the prone position). 86% of the VAEs were just detected by the use of a TEE. We only observed VAEs with a decrease in EtCO2 in the semi-sitting position. However, none of the patients had any hemodynamic changes due to the VAE. We found that surgeries in patients with a preexisting intracardial shunt such as a patent foramen ovale (PFO) less likely resulted in VAEs (42% vs. 58%).Conclusion: The semi-sitting position with TEE monitoring and a standardized protocol, including a deep central venous line is a safe and advantageous technique, taking also account of a significant rate of VAEs. VAEs also occur in the supine position, however, less frequently.

Effect of the degree of head elevation on the incidence and severity of venous air embolism in cranial neurosurgical procedures with patients in the semisitting position

2018 ◽  
Vol 128 (5) ◽  
pp. 1560-1569 ◽  
Author(s):  
Hatice Türe ◽  
M. Volkan Harput ◽  
Nural Bekiroğlu ◽  
Özgül Keskin ◽  
Özge Köner ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Hemodynamic Changes ◽  
Venous Air Embolism ◽  
Head Elevation ◽  
Significant Difference ◽  
Group 2 ◽  
Anesthetic Complications ◽  
Group 1

OBJECTIVEThe semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position.METHODSOne hundred patients undergoing an elective infratentorial craniotomy in the semisitting position were included, and each patient was assigned to 1 of 2 groups. In Group 1, each patient’s head was elevated 30° during surgery, and in Group 2, each patient’s head elevation was 45°. Patients were assigned to their group according to the location of their lesion. During surgery, the standard anesthetic protocol was used with total intravenous anesthesia, and transesophageal echocardiography was used to detect air in the blood circulation. Any air embolism seen on the echocardiography screen was classified as Grade 0 to 4. If multiple events occurred, the worst graded attack was used for statistical analysis. During hemodynamic changes caused by emboli, fluid and vasopressor requirements were recorded. Surgical and anesthetic complications were recorded also. All results were compared statistically, and a p value of < 0.05 was considered statistically significant.RESULTSThere was a statistically significant difference between groups for the total rates of venous air emboli detected on transesophageal echocardiography (22.0% [n = 11] in Group 1 and 62.5% [n = 30] in Group 2; p < 0.0001). The rate and severity of air embolism were significantly lower in Group 1 than in Group 2 (p < 0.001). The rates of clinically important venous air embolism (Grade 2, 3, or 4, venous air embolism with decreased end-tidal carbon dioxide levels and/or hemodynamic changes) were 8.0% (n = 4) in Group 1 and 50.0% (n = 24) in Group 2 (p < 0.0001). There was no association between the rate and severity of venous air embolism with patient demographics (p > 0.05). An association was found, however, between the rate of venous air embolism and the type of surgical pathology (p < 0.001); venous embolism occurred more frequently in patients with a meningioma. There were no major surgical or anesthetic complications related to patient position during the postoperative period.CONCLUSIONSFor patients in the semisitting position, an increase in the degree of head elevation is related directly to a higher rate of venous air embolism. With a 30° head elevation and our standardized technique of positioning, the semisitting position can be used safely in neurosurgical practice.

scholarly journals Venous Air Embolism Following a Dog Bite Injury in a Pediatric Patient

2020 ◽  
pp. 1-2
Author(s):  
Irim Salik ◽  
Michael Rahimi ◽  
Irim Salik
Keyword(s):  
Young Male ◽  
Neck Region ◽  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Sitting Position ◽  
Dog Bite ◽  
Head And Neck Region ◽  
Surgical Exploration ◽  
Venous Air Embolism ◽  
Bite Injuries

Young male children are more likely than adults to sustain dog bite injuries, and up to 80% of these occur in the head and neck region [1]. Timely assessment of these injuries and appropriate decisions for surgical exploration can prevent further insult. One of the most feared complications of neurosurgical procedures in the sitting position, we present the case of a venous air embolism (VAE) in the prone position during repair of a cranial vault injury from a dog bite in a 14- month-old. Informed consent was obtained from the patient's family to publish this letter to the editor.

scholarly journals Prevention of venous air embolism in paediatric neurosurgical procedures performed in the sitting position by combined use of MAST suit and PEEP

1994 ◽  
Vol 73 (6) ◽  
pp. 795-800 ◽  
Author(s):  
P.-G. MEYER ◽  
H. CUTTAREE ◽  
B. CHARRON ◽  
M.-M. JARREAU ◽  
A.-C. PERIE ◽  
...  
Keyword(s):  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Sitting Position ◽  
Venous Air Embolism ◽  
Combined Use

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.

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