Venous Air Embolism (VAE)

Research output: Chapter in Book/Report/Conference proceedingChapter


SAMPLE CASE A 77-year-old, 120 kg female presents for a craniotomy and resection of her posterior fossa tumor. The surgeon prefers her to be placed in the sitting position for the operation. She has a medical history significant for diabetes (DM), hypertension (HTN), congestive heart failure (CHF), and gastroesophageal reflux disease (GERD). She is a non-smoker with unknown exercise tolerance due to her decreased mobility secondary to osteoarthritis (OA) of her knees. What pre-operative labs and studies would you like? What monitors will you use? Should the procedure be done in the sitting position? Is VAE a concern? Will you use N2O? How would you identify a VAE? Can you prevent a VAE? How would you treat a VAE? CLINICAL ISSUES Incidence and Risk of VAE VAE can occur when the operative field is greater than or equal to 5 cm above the level of the right atrium or more specifically when there is more than a 5 cm H2O gradient between non-collapsible venous openings (e.g., diploic veins and dural sinuses) and the right atrium. a. With a VAE, the surgical site is elevated such that the pressure at that height is greater than the central venous back pressure, therefore setting the environment to entrain air. 2. Risk of occurrence is 25% and 45% during sitting cervical laminectomies and sitting posterior fossa procedures, respectively, using Doppler detection, and up to 76% during sitting posterior fossa procedures using transesophageal echocardiography [TEE] detection. a. Can also occur in the horizontal, lateral, supine, and prone positions. […]

Original languageEnglish (US)
Title of host publicationAnesthesia Oral Board Review: Knocking Out the Boards
PublisherCambridge University Press
Number of pages4
ISBN (Print)9780511657559, 9780521756198
StatePublished - Jan 1 2009
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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