Venous Air Embolus

1
Venous Air Embolus

• Department of Anesthesiology
• Rounds
• 14 February 2007

2
Venous Air Embolus

• 67 y.o. ? 3 weeks post-surgery attempt.
• Ongoing headache and dizziness (no ? from
  previous).
• Patient insists that you take it out this time.
• Discussed reduced risk of VAE in prone position,
  but not elimination.

3
Venous Air Embolus

• D Dexamethasone 10mg
• C Cefazolin 1 g
• 1 turn prone
• M Mannitol 40 g
• M2nd dose Mannitol 40g
• 2 reverse Trend. then hyperventilate

4
Venous Air Embolus

• 4 epinephrine 1 mg CPR
• 3 STP 50 mg
• 5 STP 75 mg
• 6 re-zero art line
• 7 lytes glucose 14.8, 7.35/27/378/15
• CZ Ceftazidime
• V Vancomycin
• 8 CaCl2 1 g

5
Venous Air Embolus

• First sign ETCO2 dropped from 21?3, BP dropped
  to 36/-, SaO2 to 79.
• Initial Tx Phenylephrine, fluid, advise the
  surgeon, call for help, stop Sufentanil
  Desflurane
• CPR started in prone, CVP line insertion failed

6
Venous Air Embolus

• Turn supine, continue CPR, central line inserted
  ø air!, Norepinephrine infused
• ST segments dip in leads II and V5, 0.9mm and 0.4
  mm respectively, sinus rhythm but no output
  (PEA).
• After 15 minutes of CPR halted, good response,
  patient moving arms/mouth, STs normalize
• TEE performed normal LVF, no air

7
Venous Air Embolus

• STP administered for brain protection and
  hypnotic effect
• Prophylactic antibiotics given, norepi infusion
  continued
• Patient turned prone, surgery continued
• NeuroRadiologist with Ultrasound discover that
  cyst still quite deep
• Cyst decompressed, ICP normalized no
  parenchymal edema!!!

8
Venous Air Embolus

• Surgery discontinued after U/S, cyst decompressed
• Transfer to ICU intubated, ventilated, monitored

9
Venous Air Embolus

• In ICU, moving feet, opening eyes
• Next AM, intubated, nodding/shaking head
  appropriately, moving all limbs, left arm
  sluggish
• Evening extubated, sitting in chair, buttering
  toast!!
• Plan Cyst-peritoneal shunt with non-General
  Site Anesthesiologist?