Canadian Journal of Anesthesia, Vol 12, 255-261, Copyright © 1965 by Canadian Anesthesiologists' Society

Air Embolus in Neurosurgical Anaesthesia, Its Diagnosis and Treatment

¹ Department of Anaesthesia, University of Toronto and Toronto General Hospital, Toronto, Ontario

Six cases of air embolus were noted in a total of 218 neurosurgical procedures over a period of 26 months. The operations included craniotomies postenor and middle fossa explorations cervical laminectomies and upper thoracic and cervical spine explorations. Five cases occurred with the patient in the sitting position and one in the prone position. No case occurred in conjunction with the use of positive-negative controlled ventilation.

It was found that the use of an endo oesophageal stethoscope afforded an immediate and accurate diagnosis of this condition. Changes in respiratory and cardiovascular function followed at least 30 seconds after the earliest evidence was noted by means of the oesophageal stethoscope.

The treatment of the cases consisted of preventing more air from entering through the open vein washing the air out of the heart chambers by increased venous return and supporting cardiovascular and respiratory function where necessary. By a special positioning arrangement it is possible to move the patient from the sitting to the lateral position without disturbing the draping or the operative field. As a result of this all operations were continued after a short delay and concluded successfully.

It is suggested that an endo-oesophageal stethoscope be used whenever it is considered possible that cardiac air embolism may occur.

Note:

Presented in part at the Annual Meeting of the Canadian Anaesthetists' Society at Montebello, May, 1964