Abstract SNACC-70

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Outcome Following Severe Venous Air Embolism in Neurosurgical Patients in the Sitting Position

Abcejo A, Pasternak J, Perkins W
Mayo Clinic, Rochester, Rochester, MN, USA

Introduction: Venous air embolism (VAE) is a known complication of procedures performed in the sitting position. The incidence of, and outcome following, severe venous air embolism is not well described.
Methods: After Institutional Review Board approval, the medical records of patients having neurosurgical procedures performed in the sitting position at Mayo Clinic Rochester between January 2000 and October 2013 were identified. Patient records were then reviewed for the need to abort the sitting position due to severe venous air embolism.
Results: During the study time interval, 1668 patients had neurosurgical procedures performed in the sitting position of which 1026, 526, and 115 had cervical laminectomy, craniotomy, and deep brain stimulator lead implantation respectively. Of these, 5 patients were placed in the supine position intraoperatively due to severe and continued venous air embolism (Table 1). The overall incidence of a severe VAE was 0.30%. No in-hospital deaths occurred. All but one patient were discharged either to home or a skilled nursing facility within 5 days postoperatively. Of the 5 patients, one required cardiopulmonary resuscitation. That patient had no new immediate postoperative neurologic dysfunction and was discharged postoperative day 4. Another patient experienced a generalized tonic-clonic seizure two days following the procedure. CT and MRI head imaging did not show any acute insult—only edema around the initial operative site. Otherwise, none of these 5 patients experienced any in-hospital cardiac, neurologic, respiratory or other end-organ events. A long arm central venous catheter was utilized in every patient except for the patient undergoing awake deep brain stimulator placement. A quantifiable amount of air was aspirated in only one of the VAE events.
Conclusion: The incidence of massive venous air embolism during neurosurgical procedures performed in the sitting position is rare. With appropriate expectant management, the risk of long-term sequelae following severe venous air embolism is exceedingly low. The use of a long-arm central line in a severe venous air embolism may not affect outcomes in the intraoperative or postoperative setting.
1. Jadik S et al. A standardized protocol for the prevention of clinically relevant venous air embolism during neurosurgical interventions in the semisitting position. Neurosurgery 2009; 64:533-9.
2. Matjasko J. et al. Anesthesia and surgery in the seated position: analysis of 554 cases. Neurosurgery 1985;17:695-702

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