Venous Air Embolism In Patients Undergoing Surgery In Semi-Sitting
Venous Air Embolism In Patients Undergoing Surgery In Semi-Sitting
Venous Air Embolism In Patients Undergoing Surgery In Semi-Sitting
Position : Risk Factor And Outcome Study
Martin Schott MD1, Babak Babakhani MD.,PhD.1,2,Griet Thürmer MD.1, Jan- Peter Jantzen MD., PhD.1, Jan-Hinrch Baumert MD., PhD.1
1 Academic Teaching Hospital Nordstadt, Hannover, Germany
2 Brain and Spinal Cord Injury Research Centre, Neuroscience Institute,Tehran University of Medical Sciences, Tehran Iran
Venous air embolism (VAE) is a potentially serious complication of neurosurgical procedures performed in the semi-sitting position (SSP). In this study we reviewed
the perioperative course of 802 neurosurgical procedures performed in SSP in a single center. Our main focus was on risk factors of VAE in SSP and outcome of patients with VAE episodes.
Methods: Occurrence of VAE and aspects of perioperative management were retrospectively analyzed in 802 surgeries performed in 756 consecutive patients, treated in one neurosurgical center between February 2003 and December 2010.Patient charts were reviewed for early postoperative complications, ventilator support, overall length of stay in the ICU and hospital.
Results: Episode(s) of VAE were detected in 112 patients (13.9%). Incidence of VAE was 8.8% in cervical spine surgery and 14.7% in cranial surgery.Longer duration of surgery; female gender, more central CVCs and a lower ASA classification predisposed the patients undergoing cranial surgeries in SSP to a higher risk of VAE. In cervical surgeries, sub-occipital dissection was associated with higher incidence of VAE.Comparison of the postoperative course of patients with vs. without intraoperative VAE did not unveil significant differences (log Rank test p>0.05).
Conclusion: In our patient population, managed according to a standardized protocol, VAE proved a frequent but manageable complication. VAE had no effect on postoperative course and outcome. VAE affected neither the need for postoperative ventilator support nor the overall length of stay in hospital and ICU. Our findings do not support the general abandonment of the SSP in neurosurgical procedures.