Venous Air Embolism :A Case Report

Kafrouni Hazem

doi:10.31579/2690-4861/183

Abstract

Vascular air embolism is the entrainment of air (or exogenously delivered gas) from the operative field or other communication with the environment into the venous or arterial vasculature, producing systemic effects. The true incidence of VAE may be never known, much depending on the sensitivity of detection methods used during the procedure. In addition, many cases of VAE are subclinical, resulting in no untoward outcome, and thus go unreported. That’s why a high index of suspicion is necessary to establish the diagnosis and institute the appropriate treatment. The number of procedures that place patients at risk for VAE has increased, and these procedures occur across almost all clinical specialties. Venous air emboli pose a risk anytime the surgical wound is elevated more than 5 cm above the right atrium. The presence of numerous, large, non-compressed, venous channels in the surgical field (especially during cervical procedures and craniotomies that breach the Dural sinuses) also increase the risk of VAE. The Objective of the following report is to present the case of a posterior fossa surgery, complicated by a VAE at the scalp incision and at the scalp closure. With appropriate patient selection and preparation, also the use of prudent intraoperative monitoring and anesthetic techniques, selected patients should still benefit from the optimum access to mid-line lesions, improved cerebral venous decompression, and lower intracranial pressure and enhanced gravity drainage of blood and CSF associated with the sitting position.

Highlights

The introduction of atmospheric gas into the systemic venous system, is defined as Venous Air Embolism (VAE)
With appropriate patient selection and preparation, the use of prudent intraoperative monitoring and anesthetic techniques, selected patients should still benefit from the optimum access to mid-line lesions, improved cerebral venous decompression, and lower intracranial pressure and enhanced gravity drainage of blood and CSF associated with the sitting position
The circumstances under which physicians may encounter air embolism are no longer limited to neurosurgical procedures conducted in the “sitting position” and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center

Summary

Introduction

The introduction of atmospheric gas into the systemic venous system, is defined as Venous Air Embolism (VAE). If the patient is in a sitting position, gas will travel retrograde via the internal jugular vein to the cerebral circulation, leading to neurologic symptoms secondary to increased intracranial pressure. Hypertension and systemic hypotension are noticed when patients are placed in a recumbent position, which affects the flow of gas into the right ventricle and pulmonary circulation. Rapid entry or large volumes of air entering the systemic venous circulation puts a substantial strain on the right ventricle, especially if this results in a significant rise in pulmonary artery (PA) pressures. Arterial embolism is one the known complications of VAE It occurs through the direct passage of air via anomalous structures (i.e. atrial ventricular septal defect, a patent foramen ovale, or pulmonary arterial-venous malformations) and into the arterial system. Patient transferred to ICU after 24 hours he was transferred to the floor, 7 days later he was discharged from the hospital

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