Artikel
A standardised protocol for the sitting position in neurosurgical procedures – management of venous air embolism and the role of patent foramen ovale
Ein Standard-Protokoll zur sitzenden Lagerung bei neurochirurgischen Eingriffen – der Umgang mit venösen Luftembolien und der Stellenwert eines Persistierenden Foramen Ovale
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Autoren
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Klaus-Peter Stein
- Otto-von-Guericke University Magdeburg, Neurosurgery, Magdeburg, Deutschland
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Sorusch Ataschsokhan
- Otto-von-Guericke University Magdeburg, Neurosurgery, Magdeburg, Deutschland
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Martin Schott
- DIAKOVERE Friederikenstift, Department of Anesthesiology, Hannover, Deutschland
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Belal Neyazi
- Otto-von-Guericke University Magdeburg, Neurosurgery, Magdeburg, Deutschland
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Jan-Peter Jantzen
- University Medical Centre, Johannes Gutenberg University Mainz, Department of Anesthesiology, Mainz, Deutschland
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I. Erol Sandalcioglu
- Otto-von-Guericke University Magdeburg, Neurosurgery, Magdeburg, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: To describe the clinical and treatment characteristics of the sitting position during neurosurgical procedures and the role of patent foramen ovale (PFO) in the management of venous air embolism (VAE).
Methods: All surgical procedures were performed in the sitting position and under general anesthesia despite a PFO. We used a standardized protocol for 1. the sitting position, 2. preoperative detection of PFO and monitoring of VAE (trans-esophageal echocardiography TEE; capnometry), 3. surgical and 4. anesthesiological management of VAE. VAE episodes were allocated to two groups, based on severity (VAE °I: positive TEE and/or air aspiration; VAE°II: VAE°I plus drop in expiratory CO2 by more than 10% and/or decrease in mean arterial pressure by more than 20%).
Results: During 2012 and 2016, a total 182 patients were included (age 59± 6a, range 16-89a) in the study. Surgical procedures comprised spinal (N=37, 20%) and cranial approaches (N=145, 80%; intraaxial N=51, 35%, extraaxial N=94, 65%). Duration of surgery was 192±85 min (range 48-484min). Twenty-two patients (12%) exhibited a PFO. At least one episode of VAE occurred in 48 patients (26%). A VAE°I occurred in 39 (81%) and a VAE°II in 9 (19%) cases, respectively. All VAE events were managed safely and successfully following our institutional standards. Comparison of patients’ postoperative course with and without VAE, VAE°I and °II unveiled no differences in terms of PFO, overall length of stay on intensive care unit and in hospital.
Conclusion: Following a standardized protocol, the sitting position and the management of VAE is safe and effective in experienced surgical and anesthesiological hands. Under consideration of our data, the role of PFO in the sitting position needs a thorough reevaluation, such as the need for a VAE classification.
