Head-down tilt position successfully prevent severe brain air embolism.

Area of Science:

• Cardiothoracic Surgery
• Vascular Complications
• Anesthesiology

Background:

• Thoracic surgery, specifically segmentectomy, involves insufflating air into bronchi for margin detection.
• This procedure carries a risk of iatrogenic air embolism, a potentially fatal complication.
• Intraoperative air embolism can lead to sudden cardiac arrest.

Observation:

• A patient undergoing left superior division segmentectomy via open thoracotomy experienced sudden cardiac arrest.
• The event occurred immediately after air insufflation into the bronchus while the patient was in a head-down position.
• Immediate intervention included open-chest cardiac massage and initiation of low-temperature therapy.

Findings:

• The patient successfully recovered from the intraoperative cardiac arrest.
• The head-down position is hypothesized to prevent cerebral air embolism by directing air away from the brain.
• Continuous open-chest massage and therapeutic hypothermia mitigated systemic damage from the air embolism.

Implications:

• The head-down position during thoracic procedures may be a crucial protective measure against severe brain injury from air embolism.
• Prompt and aggressive resuscitation techniques, including cardiac massage and hypothermia, are vital for managing intraoperative air embolism.
• This case highlights the importance of patient positioning and preparedness for managing rare but critical surgical complications.