Abstract
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.
Résumé
Objectif
Présenter un cas non mortel d’aéroembolie veineuse peropératoire (AEV) survenue pendant une craniotomie vigile. L’AEV présentait des caractéristiques cliniques inhabituelles.
Éléments cliniques
L’AEV qui survient pendant la craniotomie vigile n’a pas été souvent rapportée. Le patient que nous décrivons a présenté une toux persistante suivie de tachypnée, d’hypoxie et d’une baisse du CO2 télé-expiratoire pendant l’ouverture durale pour une craniotomie vigile en décubitus dorsal. Les variables hémodynamiques ont été stables pendant l’épisode, sauf pour l’hypertension transitoire. Nous avons d’abord écarté la possibilité d’une obstruction des voies aériennes et un faible débit cardiaque pour en arriver au diagnostic d’embolie gazeuse. Le patient a immédiatement réagi au traitement standard de l’embolie gazeuse et il s’est remis sans complication.
Conclusion
Ce cas illustre un AEV pendant une craniotomie vigile et souligne l’importance d’un diagnostic précoce pour le traitement.
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Balki, M., Manninen, P.H., McGuire, G.P. et al. Venous air embolism during awake craniotomy in a supine patient. Can J Anesth 50, 835–838 (2003). https://doi.org/10.1007/BF03019383
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DOI: https://doi.org/10.1007/BF03019383