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Possible venous air embolism during open eye surgery in a child

[Possible embolie gazeuse veineuse lors d’une chirurgie à œil ouvert chez un enfant]

From the Department of Anesthesiology, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada.

Address correspondence to: Dr. Pierre Ruest, Department of Anesthesiology, CHU Sainte-Justine, 3175 Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5, Canada. Phone: 514-345-4931, ext. 4733; Fax: 514-345-4798; E-mail: pierre.ruest.hsj{at}ssss.gouv.qc.ca

Purpose: Although venous air embolism is a well recognized complication within most surgical subspecialties, it has only been reported recently during eye surgery in one adult, and never before in a child. We describe the case of a 17-month-old boy who sustained a possible air embolism during repair of an open trauma of his right eye.

Clinical features: A vitrectomy through the pars plana with air-fluid exchange of the posterior chamber was performed under general anesthesia to remove a foreign body which had impaled the optic nerve. A few minutes after removal of the foreign body, a notable decrease in end-tidal CO₂, oxygen saturation and arterial blood pressure occurred, requiring administration of a high inspired oxygen fraction and vasopressors. Venous air embolism was strongly suspected after other causes of a decrease of end-tidal CO₂ and hypoxemia had been excluded. An arterial blood gas confirmed hypoxemia and respiratory acidosis.

Conclusion: Although venous air embolism is a rare complication of eye surgery, it should nevertheless be considered as a possible complication during air-fluid exchange vitrectomy in children.