Anaes SAQs · Neuroanaesthesia
Venous air embolism in the sitting position: detection, prevention, and management
Final-examination SAQ for venous-air-embolism-sitting-position.
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ANZCAFRCAEDAICABAFCAI
Prompt
During sitting posterior fossa surgery the EtCO2 falls abruptly from 34 to 18 mmHg and BP drops. Discuss diagnosis, monitoring hierarchy, immediate management, and preventive strategies for future cases.
Model answer
Diagnosis (3). VAE until proven otherwise; differential includes low CO and circuit issues, as the cited detection/management teaching below states.[4]
Monitors (4). TOE > precordial Doppler > PAP > EtCO2 > SpO2 hierarchy, as the cited detection/management teaching below states.[4]
Management (5). Surgeon floods/wax; stop N2O; FiO2 1.0; aspirate CVP; Durant position; circulatory support, as the cited detection/management teaching below states.[4]
Prevention (3). PFO screening when relevant; venous pressure; surgical technique; team brief, as the cited detection/management teaching below states.[5]
References5ShowHide
- [1]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia, 2015.PMID 26556848
- [2]Davidson AJ et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet, 2016.PMID 26507180
- [3]Sikich N, Lerman J Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology, 2004.PMID 15114210
- [4]Hurth H, Ebner FH, Clement E, Naros G, Rosenberger P, et al. The risk of intraoperative venous air embolism from neurosurgical procedures performed in the lounging position: an in-depth analysis of detection, management, and outcomes of 1000 consecutive cases J Neurosurg, 2025.PMID 39303312
- [5]Hurth H, Ebner FH, Clement E, Naros G, Rosenberger P, et al. The risk of intraoperative venous air embolism from neurosurgical procedures performed in the lounging position: an in-depth analysis of detection, management, and outcomes of 1000 consecutive cases J Neurosurg, 2025.PMID 39303312