Venous air embolism: an under-recognized and potentially catastrophic complication in orthopaedic surgery

Venous air embolism (VAE) is the entry of air or other medical gases into the central venous system, producing an air embolism to the right heart or pulmonary artery. VAE is a largely iatrogenic complication with potentially devastating sequelae that can occur in a variety of surgical procedures.

Within orthopaedics, VAE has been associated with both open and arthroscopic surgeries with the patient in a variety of positions (ie, prone, supine, sitting). These articles, as well as reports of VAE in other surgical settings outside of orthopaedics, are examined.

Diagnosis of VAE requires a high index of suspicion, as clinical presentation ranges from completely asymptomatic to fatal cardiopulmonary collapse. The vigilant surgeon should carefully watch for air entry at the operative site and the astute anesthesiologist must closely monitor end-tidal CO2 (ETCO2). Prevention of VAE is of paramount importance, as management is largely supportive and aimed at inhibiting further air ingress.