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Venous air embolism during awake craniotomy in a supine patient

[Aéroembolie veineuse pendant la craniotomie chez un patient en décubitus dorsal]

Mrinalini Balki, MBBS MD^*, Pirjo H. Manninen, MD FRCPC^*, Glenn P. McGuire, MD^*, Hossam El-Beheiry, MBBCH PHD FRCPC^* and Mark Bernstein, MD FRCSC

^* From the Department of Anesthesia
and the Division of Neurosurgery, The Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Pirjo H. Manninen, Department of Anesthesia, The Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603-6494; E-mail: Pirjo.Manninen{at}uhn.on.ca

Purpose: To report a non-fatal case of intraoperative venous air embolism (VAE) during an awake craniotomy. VAE presented with unusual clinical features.

Clinical features: VAE during an awake craniotomy has not been reported frequently. The patient we describe presented with persistent coughing followed by tachypnea, hypoxia and reduction in end-tidal CO₂ during dural opening while undergoing an awake craniotomy in the supine position. Cardiovascular variables were stable during the episode except for transient hypertension. Having ruled out airway obstruction and low cardiac output, we concluded that air embolism was the cause. The patient responded immediately to the standard treatment of air embolism and recovered without any complication.

Conclusion: This case illustrates a VAE during an awake craniotomy and emphasizes the importance of early diagnosis in the management.