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Related Experiment Videos

Venous air embolism during a craniofacial procedure.

R J Phillips1, J B Mulliken

  • 1Division of Plastic and Maxillofacial Surgery, Harvard Medical School, Boston, Mass.

Plastic and Reconstructive Surgery
|July 1, 1988
PubMed
Summary

Venous air embolism can occur during craniofacial surgery when the surgical site is above heart level. Monitoring for and managing this risk is crucial for patient safety in complex procedures.

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Cardiovascular Surgery

Background:

  • Venous air embolism (VAE) is a potential complication in surgical procedures where the operative field is positioned above the heart.
  • Craniofacial operations, particularly those involving craniotomy with high-torque instruments, may pose a risk for VAE.

Observation:

  • The report details a case where craniotomy with a high-torque craniotome is suspected as the cause of VAE.
  • Diagnostic methods for VAE include transesophageal Doppler probe, echocardiography (transesophageal or external), and end-tidal gas monitoring (N2 and CO2).

Findings:

  • Management strategies for VAE involve controlling air entry, aspirating air from the right atrium, and discontinuing nitrous oxide.
  • If initial treatments fail, lowering the operative field below heart level and terminating the procedure are recommended.

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  • In cases of hemodynamic compromise, cardiac massage and direct aspiration may be necessary.

    • Implications:

    • The actual incidence of VAE in craniofacial surgery might be underestimated.
    • Routine placement of monitoring equipment to detect intracardiac air is recommended for major craniofacial procedures with potential for air embolism.