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Possible air embolism during eye surgery.

Thomas Ledowski1, Felix Kiese, Silke Jeglin

  • 1*Department of Anaesthesiology and Intensive Care Medicine, University Hospital Kiel; and †Eye Hospital Bellevue, Kiel, Germany.

Anesthesia and Analgesia
|May 28, 2005
PubMed
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A rare complication of pars plana vitrectomy is air embolism. During eye surgery, sudden vital sign changes suggest air embolism, which resolves when air flushing stops.

Area of Science:

  • Ophthalmology
  • Surgical Complications
  • Cardiovascular Physiology

Background:

  • Pars plana vitrectomy is a common surgical procedure for various retinal conditions.
  • Air-fluid exchange is a critical step in vitrectomy, involving the replacement of vitreous humor with air.
  • Understanding potential complications is crucial for patient safety during ophthalmic surgery.

Observation:

  • A case of suspected venous air embolism occurred during a three-port pars plana vitrectomy.
  • The patient exhibited sudden tachycardia, decreased oxygen saturation, and reduced end-tidal carbon dioxide.
  • A characteristic "mill-wheel" murmur was auscultated, indicative of air in the cardiac chambers.

Findings:

  • Intraocular air flushing was identified as the likely source of air entry into the circulation.

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  • Other potential causes, including thromboembolic events, were systematically excluded.
  • Cessation of intraocular air flushing led to rapid normalization of the patient's vital signs.

    • Implications:

    • Air embolism is a rare but serious potential complication during pars plana vitrectomy with air-fluid exchange.
    • Ophthalmologists should maintain a high index of suspicion for air embolism in patients presenting with sudden hemodynamic instability during or after air infusion.
    • Prompt recognition and management, including discontinuation of air infusion, are essential to prevent adverse outcomes.