A case report of venous air embolism induced by bone marrow cavity irrigation

Area of Science:

• Pediatric Orthopedic Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Venous air embolism (VAE) is a rare yet life-threatening complication during surgical procedures involving vascular structures or pressurized irrigation.
• Pediatric patients undergoing orthopedic surgery are susceptible to VAE, particularly during procedures like bone marrow cavity irrigation.

Purpose of the Study:

• To report a rare case of severe VAE in a pediatric patient during femoral osteomyelitis surgery.
• To emphasize the importance of prompt diagnosis and management of VAE in pediatric orthopedic procedures.

Main Methods:

• A 3-year-old girl with femoral osteomyelitis underwent surgery involving bone marrow cavity irrigation.
• The patient developed rapid clinical deterioration indicative of VAE.
• Diagnosis was confirmed via bedside echocardiogram, and emergency interventions were initiated.

Main Results:

• The patient experienced sudden drops in end-tidal carbon dioxide, oxygen saturation, pulse rate, and blood pressure.
• Interventions including catheter aspiration, 100% oxygen, left lateral positioning, and cessation of irrigation rapidly resolved symptoms.
• The patient recovered fully without neurological deficits.

Conclusions:

• This case underscores the critical need for heightened vigilance during pediatric orthopedic procedures involving potential air introduction.
• Immediate echocardiographic assessment is crucial for rapid VAE diagnosis.
• Timely and appropriate emergency interventions are vital to prevent morbidity and mortality associated with VAE in children.