A precipitous cause of iatrogenic venous air embolism in pediatric posterior fossa tumor

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.

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Venous air embolism in a child undergoing posterior fossa craniotomy: a case report

Canadian Anaesthetists Society journal / Journal de la Société canadienne des anesthésistes ◽

10.1007/bf03011488 ◽

1984 ◽

Vol 31 (1) ◽

pp. 86-90 ◽

Cited By ~ 2

Author(s):

Susan S. Porter ◽

Robert C. Boyd ◽

Maurice S. Albin

Keyword(s):

Case Report ◽

Posterior Fossa ◽

Air Embolism ◽

Venous Air Embolism

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Posterior Fossa

10.2310/anes.18068 ◽

2019 ◽

Author(s):

Talia S. Vogel ◽

Penny P. Liu

Keyword(s):

Posterior Fossa ◽

Preoperative Evaluation ◽

Cranial Nerves ◽

Air Embolism ◽

Neurophysiological Monitoring ◽

Posterior Fossa Surgery ◽

Neurophysiologic Monitoring ◽

Venous Air Embolism ◽

Brainstem Stroke ◽

Air Embolus

The posterior fossa houses essential brainstem nuclei, cranial nerves, cerebral vasculature, and mechanisms for cerebrospinal fluid drainage. Anesthetic considerations for posterior fossa surgery include thorough preoperative evaluation, intraoperative monitoring, and anesthetic planning to allow neurophysiological monitoring. Careful positioning is imperative to optimize surgical conditions and to risk stratify patients for complications, including venous air embolus. Venous air embolus is a common complication of posterior fossa surgery given the plentitude of venous channels in the posterior fossa, and rapid recognition is key to managing this complication. Posterior fossa surgery also has a number of other known complications including postoperative apnea, prolonged ventilation, and possible brainstem stroke. This review contains 4 tables, 1 video, and 31 references. Keywords: Posterior fossa surgery, Brainstem surgery, Neuroanesthesiology, Venous air embolism/embolus, Sitting craniotomy, Prone craniotomy, Transesophageal echocardiogram, Neurophysiologic monitoring

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