Air embolism during craniotomy in the seated position: a comparison of methods for detection

A case of air embolism sufficient to cause cardiovascular collapse is reported. This occurred during biopsy of the trigeminal nerve with the patient in the seated position. The use of an end-tidal carbon-dioxide monitor was a better indicator than a precordial doppler of the embolic problem. It allowed rapid detection and prompt resuscitation to be carried out. Air embolism is a significant and potentially fatal problem in clinical practice. It has been widely reported during neurosurgical, head and neck, and gynaecological procedures, and increasingly during laparoscopic procedures where carbon dioxide or air may be embolized systemically. A discussion of the incidence and pathophysiology as well as a review of the methods of diagnosis and management follows.