LETTERS TO THE EDITOR: Letters & Announcements
We thank Drs. Seubert and Gravenstein for their appreciation of our findings and their comments. We can only agree with their comment that movement of previously entrained air entering the circulation during other surgery at risk for air embolism (such as hip arthroplasty), at the end of surgery, or after surgery due to changing ventilation patterns (such as positive end-expiratory pressure release), or change of patient positions can severely impair the patient’s hemodynamic stability. Intraoperative transesophageal echocardiography (TEE) is not only the most sensitive monitor of venous air embolism, but also the most useful monitor to visualize directly the cardiac performance. It is this double function of TEE, the recognition of venous air embolism in the heart and the possibility to observe to what degree the cardiac function is affected, which makes TEE so useful in our daily practice.
We can only hope that the increasing perception of how frequent venous air embolism really is and that it can occur with so many different types of surgery will lead us to further advance the distribution of TEE devices and to train not only cardiac anesthesiologists in this immensely important technique.
The essential message of our investigation is to use TEE in all surgery at risk for venous air embolism and to continue TEE monitoring after surgery until the patient is in the supine position and positive end-expiratory pressure has been released to ensure that sudden hemodynamic problems due to reoccurrence of air in the circulation are not missed.
Thomas M. Hemmerling, MD, DEAA
Hubert Schmitt, MD