Vascular Air Emboli During the Perioperative Period

Abstract

Vascular air embolism is of particular concern to the anesthesiologist. The unique combination of factors encountered during procedures requiring sedation or general anesthesia increases the risk for its occurrence. Air embolism can have devastating consequences and result in morbidity and even mortality. Prevention and early diagnosis are key in mitigating the effects of this event. This manuscript provides a comprehensive review of the current knowledge and new developments in vascular air embolism. Our understanding of procedures during which vascular air embolism can occur has expanded. Increased implementation of transesophageal echocardiography (TEE) for non-cardiac surgeries has made echocardiography one of the most versatile intraoperative diagnostic methods. Treatment is mostly limited to prevention of further air entrainment, supportive care, and resuscitation. Vascular air emboli can frequently be prevented using meticulous attention in handling indwelling vascular catheters and surgical technique. If, despite precautions, a vascular air embolus occurs, rapid diagnosis can aid in implementation of actions that prevent further air entrainment, support cardiopulmonary function, and mitigate the effect of the air embolus present in the vascular system.