Background: Venous air embolism
) is a well-described complication of neurosurgical procedures performed in the seated position
. Although most often clinically insignificant, VAE
may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study.
Patients undergoing a neurosurgical procedure in the seated position
at a single institution between January 2000 and October 2013 were identified. Corresponding medical records, neurosurgical operative reports, and computerized anesthetic records were searched for intraoperative VAE
diagnosis. Extreme VAE
was defined as a case in which urgent seated to level position change was performed for patient safety. Detailed examples of extreme VAE
cases are described, including their intraoperative course, VAE
management, and postoperative outcomes.
There were 8 extreme VAE
(0.47% incidence), 6 during suboccipital craniotomy (1.5%) and 2 during deep brain stimulator implantation (0.6%). VAE
-associated end-expired CO2
and mean arterial pressure reductions rapidly normalized following position change. No new neurological deficits or cardiac events associated with extreme VAE
were observed. In 5 of 8, surgery
was completed. Central venous catheter
placement and aspiration during VAE
played no demonstrable role in patient outcome.
during seated intracranial neurosurgical procedures is infrequent. Extreme VAE
exchange and hemodynamic consequences from VAE
were transient, recovering quickly back to baseline without significant neurological or cardiopulmonary morbidity.