Anaes Cases · Neuroanaesthesia
The venous air embolism in the sitting position
The short case — the venous air embolism in the sitting position. The negative pressure in the upright venous sinuses draws the air; the detection (the precordial Doppler, the end-tidal nitrogen); the management (the flooding of the field, the lowering of the head, the aspiration via the CVC, the resuscitation).
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A posterior fossa tumour is resected in the sitting position. The precordial Doppler is in place and the end-tidal CO2 and the arterial line are monitored. Midway through, the end-tidal CO2 falls abruptly from 35 to 24 mmHg, the precordial Doppler develops a loud churning (the mill-wheel) murmur, the systolic BP falls from 120 to 75 mmHg, and the oxygen saturation falls to 90 per cent. Diagnose and manage.[40071980]
References2ShowHide
- [1]Bou Sleiman V, et al. Anesthetic management of neurosurgical emergencies. Curr Opin Anaesthesiol, 2025.PMID 40071979
- [40071980]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.