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Repeated attacks of venous air embolism during craniotomy--a case report
1Department of Anesthesiology, Veterans General Hospital-Taipei and School of Medicine, National Yang-Ming University, 201, Sec. 2, Shi-Pai Rd., Pei-Tou 112, Taipei, Taiwan, R.O.C.
Abstract:
Venous air embolism (VAE) is not uncommon during craniotomy, but repeated attacks of VAE during a single surgical procedure is rarely seen. We report a successful intraoperative management of repeated attacks of air embolism in a patient who sustained craniotomy for intracranial hemorrhage (ICH) in prone position. A 70-year-old male suffering from hemorrhage in the right cerebellar hemisphere with impending brainstem herniation was scheduled for craniotomy. He had history of hypertension but it was not well controlled with medical treatment. Emergent craniotomy for removal of blood clot resulting from ICH was performed. During the operation, sudden decrease of end-tidal CO2 (EtCO2) level, fall of blood pressure and increase of central venous pressure (CVP) were noted. Since air bubbles were retrieved from CVP catheter venous air embolism was highly suspected. With prompt diagnosis and proper management, we successfully improved the patient's hemodynamic status and he was discharged without any sequelae. Early detection together with aggressive treatment is the only way in the management of intraoperative venous air embolism.
Insights
Repeated venous air embolism (VAE) during craniotomy is rare. This case report details successful intraoperative management of multiple VAE attacks, emphasizing prompt diagnosis and treatment for patient recovery.
Area of Science:
- Neurosurgery
- Anesthesiology
- Critical Care Medicine
Background:
- Venous air embolism (VAE) is a known complication during craniotomy, particularly in the prone position.
- Intracranial hemorrhage (ICH) necessitates emergent surgical intervention, often involving complex positioning.
- Managing recurrent VAE during a single procedure presents significant clinical challenges.
Observation:
- A 70-year-old male with uncontrolled hypertension presented with cerebellar ICH and impending brainstem herniation.
- During emergent craniotomy in the prone position, the patient experienced sudden drops in end-tidal CO2 (EtCO2), hypotension, and elevated central venous pressure (CVP).
- Air bubbles aspirated from the CVP catheter confirmed suspected venous air embolism.
Findings:
- Prompt identification of VAE through hemodynamic monitoring (decreased EtCO2, hypotension, increased CVP) was crucial.
- Aggressive intraoperative management successfully stabilized the patient's condition.
- The patient recovered without any neurological sequelae following the successful management of repeated VAE episodes.
Implications:
- This case highlights the importance of vigilant monitoring for VAE during neurosurgical procedures.
- Early detection and immediate, decisive intervention are critical for managing intraoperative VAE and improving patient outcomes.
- The successful management of repeated VAE underscores the efficacy of prompt diagnostic and therapeutic strategies in neuroanesthesia.