Venous air embolism during deep brain stimulation surgery in an awake supine patient

Deep brain stimulation (DBS) of the subthalamic nucleus and globus pallidus is used to improve Parkinsonian symptoms and reduce levodopa-induced motor complications in Parkinson's disease (PD). This procedure is usually performed with minimal or no sedation to allow accurate feedback from patients during surgery. Venous air embolism (VAE) has been previously reported in patients undergoing awake neurosurgical procedures for brain tumors or pallidotomy for PD. We describe a case of intraoperative VAE in an awake, supine patient while undergoing DBS surgery for PD who presented with coughing, tachypnea and hypoxemia. The difference in clinical presentation between VAE in awake vs. anesthetized patients is discussed as are intraoperative monitoring techniques and management options.