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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
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
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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.

Type
Original Article
Copyright
2004 European Society of Anaesthesiology

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