Venous air embolism and selective denervation for torticollis

Selective denervation to relieve severe torticollis requires surgery with the patient in the sitting position. Nerve stimulation is used to guide the procedure; therefore, patients undergo general anesthesia without muscle relaxation. Because of the risk of venous air embolism (VAE), monitoring with precordial Doppler and a multiorifice right atrial catheter has been recommended. To document the incidence of VAE and, thus, the effectiveness of monitors to detect it, consecutive patients who underwent selective peripheral denervation for torticollis between June 1993 and July 1994 were studied retrospectively, and those who underwent the procedure between August 1994 and February 1996 were studied prospectively. No VAE was documented in the retrospective group (n = 31). In the prospective group (n = 69), precordial Doppler detected one episode of VAE that lasted < 20 s and had no clinical sequelae. The incidence of complications from right atrial catheter insertion was 8% (carotid puncture, hematoma, inability to cannulate) but with no permanent sequelae. We conclude that VAE is infrequent and self-limited in association with selective denervation for torticollis. While monitoring with precordial Doppler for patients undergoing denervation for torticollis is indicated, the use of a right atrial catheter is of limited value because of associated complications and increased operating room time and cost.