Nonfatal Venous Air Embolism During Cesarean Section

Abstract

Venous air embolism occurs in more than half of all cesarean sections. Predisposing factors in pregnancy include uterine surgery and manipulation, hypovolemia, and maternal positioning. The presence of an intracardiac septal defect and use of certain anesthetic agents place the patient at greater risk of fatal air embolus. The sudden development of hypotension, hypoxia, and a drop in end-tidal CO2 are typical signs of this condition. Supportive therapy includes flooding the surgical field with normal saline, placing the patient in reverse Trendelenburg with a left-lateral tilt, and discontinuation of nitrous oxide anesthesia. We report a case that was diagnosed and successfully managed during a cesarean section and review the literature on prophylaxis, diagnosis, and therapy of this condition. A high index of suspicion and use of precordial Doppler studies in the future will permit earlier diagnosis and therapy and decreased mortality from this common condition. The phenomenon of venous air embolism in the intrapartum period has been well described in the anesthesia literature but there have been few case reports of patients having this complication in the recent obstetrical literature. We wish to describe the clinical course and successful management of a patient with this complication during cesarean section and provide a review of the literature on the phenomenon of venous air embolism in the obstetrical patient with particular emphasis on pathophysiology, detection, and treatment.