Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T07:02:03.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparative incidence of venous air embolism and associated hypotension in adults and children operated for neurosurgery in the sitting position

Published online by Cambridge University Press:  23 December 2004

P. K. Bithal ,
M. P. Pandia ,
H. H. Dash ,
R. S. Chouhan ,
B. Mohanty  and
N. Padhy
P. K. Bithal
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesia, New Delhi, India
M. P. Pandia
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesia, New Delhi, India
H. H. Dash
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesia, New Delhi, India
R. S. Chouhan
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesia, New Delhi, India
B. Mohanty
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesia, New Delhi, India
N. Padhy
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesia, New Delhi, India
Get access

Extract

Summary

Background and objective: Venous air embolism is a constant threat during neurosurgery performed in the sitting position. No large prospective study has compared the incidence of venous air embolism and associated hypotension between adults and children.

Methods: Four hundred and thirty patients (334 adults, 96 children) scheduled to undergo planned posterior fossa surgery in the sitting position (between January 1989 to December 1994) were studied with end-tidal carbon dioxide monitoring. Intraoperatively, a sudden and sustained decrease in end-tidal carbon dioxide tension of >0.7 kPa was presumed to be due to venous air embolism. Management during the episode was on the established guidelines. Hypotension (decrease in systolic arterial pressure of 20% or more from the previous level) was treated with crystalloids and/or a vasopressor.

Results: Capnometry detected a 28% incidence rate of air embolism in adults (93/334) and a 22% incidence rate in children (21/96) (P = 0.29). In both groups, the highest incidence rate of embolism took place during muscle handling (44% of adults versus 38% of children, P = 0.8). Embolic episodes were accompanied by hypotension in 37% of adults (34/93) and in 33% of children (7/21) (P = 0.98). To restore arterial pressure to pre-embolic levels, 53% of adults (18/34) and 43% of children (3/7) were administered vasopressors (P = 0.94). There was no intraoperative mortality. The surgical procedure on one adult was abandoned because of persistent hypotension following the embolic episode.

Conclusion: The incidence of venous air embolism and consequent hypotension is similar in adults and children.

Keywords

ANAESTHESIA, neurosurgicalINTRACRANIAL EMBOLISM, airMONITORING, PHYSIOLOGICAL, intraoperative, monitoring end tidal carbon dioxideNEUROSURGICAL PROCEDURES, craniectomyPOSTURE, sitting position
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 7 , July 2004 , pp. 517 - 522
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bedal AE, Berge KH, Losasso TJ. Paradoxical air embolism during venous air embolism. Transesophageal echocardiographic evidence of transpulmonary air passage. Anesthesiology 1994; 80: 947–950.Google Scholar
Tommasino C, Beretta L, Della'Acqua A, Rizzardi R, Ferrari da Passano C. Use of intracranial Doppler for venous air embolism monitoring in sitting position. Technical Note. Minerva Anestesiol 1992; 58: 1311–1314.Google Scholar
Tommasino C, Rizzardi R, Beretta L, Venturino M, Piccoli S. Cerebral ischemia after venous air embolism in the absence of intracardiac defect. J Neurosurg Anesthesiol 1996; 8: 30–34.Google Scholar
Schaffranietz L, Gunther L. Neurosurgical operations in sitting position: results of a survey in Germany. Anaesthesist 1997; 46: 91–95.Google Scholar
Schaffranietz L, Grothe A, Olthoff D. Use of sitting position in neurosurgery: results of a 1998 survey in Germany. Anaesthesist 2000; 49: 269–274.Google Scholar
Elton RJ, Howell RSC. The sitting position in neurosurgical anaesthesia: a survey of British practice in 1991. Br J Anaesth 1994; 73: 247–248.Google Scholar
Michenfelder JD, Martin JT, Altenburg BM, Rehder K. Air embolism during neurosurgery. An evaluation of right atrial catheter for diagnosis and treatment. JAMA 1969; 208: 1353–1358.Google Scholar
Maroon JC, Edmonds-Seal J, Campbell RL. An ultrasonic method for detecting air embolism. J Neurosurg 1981; 54: 75–78.Google Scholar
Gildenberg PL, O'Brien RA, Britt WJ, Frost EAM. The efficacy of Doppler monitoring for the detection of venous air embolism. J Neurosurg 1981; 54: 75–78.Google Scholar
Mammoto T, Hayashi Y, Kuro M. Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position. Detection by transesophageal echocardiography. Acta Anaesth Scand 1998; 42: 643–647.Google Scholar
Iwabuchi T, Sobata E, Ebina K, Tsubakisaka H. Dural sinus pressure: various aspects in human brain surgery in children and adults. Am J Physiol 1986; 250: 389–396.Google Scholar
Harrison EA, Mackersie A, McEwan A, Facer E. The sitting position for neurosurgery in children: a review of 16 years’ experience. Br J Anaesth 2002; 88: 12–17.Google Scholar
Meyer PG, Cuttarree H, Charron B, Jarreau MM, Perie AC, Sainte-Rose C. Prevention of venous air embolism in paediatric neurosurgical procedures performed in sitting position by combined use of MAST suit and PEEP. Br J Anaesth 1994; 73: 795–800.Google Scholar
Von Gosseln H, Samii M, Suhr D, Bini W. The lounging position for posterior fossa surgery: anesthesiological considerations regarding air embolism. Child's Nerv Syst 1991; 7: 368–374.Google Scholar
Cucchiara RF, Bowers B. Air embolism in children undergoing suboccipital craniotomy. Anesthesiology 1982; 57: 338–339.Google Scholar
Matjasko J, Petrozza P, Cohen M, Steinberg P. Anesthesia and surgery in the seated position: analysis of 554 cases. Neurosurgery 1985; 17: 695–702.Google Scholar
Adornato DC, Gildenberg PL, Ferrario CM, Smart J, Frost EAM. Pathophysiology of intravenous air embolism in dogs. Anesthesiology 1984; 49: 120–127.Google Scholar
Muller H, Brahler A, Gerlach I, Gerlach H, Becker W, Hempelmann G. Diagnostische, und prognostische Bedeutiug haemodynamischer und respiratorischer parameter bei venoser Luftembolie. Anaesthesist 1984; 33: 493–498.Google Scholar
Grady MS, Bedford RF, Park TS. Changes in superior sagittal sinus pressure in children with head elevation, jugular venous compression, and PEEP. J Neurosurg 1986; 65: 199–202.Google Scholar
Fuchs G, Schwarz G, Stein J, Kaltenbock F, Baumgartner A, Oberbauer RW. Doppler color-flow imaging: screening of a patent foramen ovale in children scheduled for neurosurgery in the sitting position. J Neurosurg Anesthesiol 1998; 10: 5–9.Google Scholar
Toung T, Ngeow YK, Long DL. Comparison of the effects of positive end expiratory pressure and jugular venous compression on canine cerebral venous pressure. Anesthesiology 1984; 61: 169–172.Google Scholar
Smith DS, Osborn I. Posterior fossa: anesthetic considerations. In: Cottrell JE, Smith DS, eds. Anesthesia and Neurosurgery. New York, USA: Mosby, 2001; 335–351.
Gottdiener JS, Papademetrior V, Notargiacomo A. Incidence and cardiac evidence of arterial embolization via non-cardiac shunt. Arch Int Med 1988; 148: 795–800.Google Scholar
Perkins NAK, Bedford RF. Hemodynamic consequences of PEEP in seated neurological patients – implications for paradoxical air embolism. Anesth Analg 1984; 63: 429–432.Google Scholar