gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Incidence and intensive care management of intraoperative air embolism in semisitting position

Meeting Abstract

  • Florian H. Ebner - Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Deutschland
  • Karl-Heinz Decker - Department of Anesthesiology, Tübingen, Deutschland
  • Helene V. Hurth - Tübingen, Deutschland
  • Felix Behling - Tübingen, Deutschland
  • Ulrich Birkenhauer - Tübingen, Deutschland
  • Jochen Steiner - Tübingen, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.28.05

doi: 10.3205/17dgnc349, urn:nbn:de:0183-17dgnc3491

Published: June 9, 2017

© 2017 Ebner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: To report about intensive care therapies after intraoperative air embolism in semisitting position.

Methods: We analyzed operating reports, ICU charts and imaging of 244 consecutive patients operated in semisitting position for a lesion in the cerebello-pontine angle. We evaluated the intraoperative and postoperative course as well as in 87 patients specifically the observed changes on intraoperative transesophaeal echography graded from 0 (No air embolism) to IV (Air bubbles in the TEE with a drop of EtCO2>3mmHg and drop of the middle arterial blood pressure >20% and/or increase of heart rate >40%) or V (Grade IV causing hemodynamic instability requiring cardiopulmonary resuscitation). The cases of two patients suffering a prolonged ICU stay due to intraoperative air embolism are illustrated.

Results: According to the TEE grading system 41,5% had no air embolism (grade 0), 45% minimal air bubbles (grade I), 9% air bubbles with a drop of EtCO2 ≤3mmHg (grade II) and 4,5% air bubbles with a drop of EtCO2>3 mmHg (grade III). No grade IV or V occurred. All patients with intraoperative air embolism have a postoperative chest x-ray. The blood gas analysis is assessed paying special attention to the Horowitz index. Antioxidant drugs are administrated. From the 244 consecutive patients 2 needed prolonged intensive care because of the intraoperative air embolism in semisitting position: The first patient, a 55 year old woman operated on a petrous bone meningioma developed atelectasis on the chest X-ray with mild functional disturbance. She was extubated on postoperative day 1. The further course was uneventful. The second patient, a 58 year old man operated on a vestibular schwannoma T4A developed an acute respiratory distress syndrome (medium-severe according to the Berlin definition) requiring prolonged intubation and ventilation. The intensive care included fluid restriction, avoidance of colloid fluids, administration of antioxidant drugs, protective ventilation with low tidal volumes. The patient showed a protracted hospital stay but finally recovered well and turned back to his professional life. Grade and time duration of the air embolism predict the immediate postoperative course. All patients with air embolism grad I to III showed good medium and long term outcomes.

Conclusion: Grade of intraoperative air embolism as well as time duration of air embolism are significant risk factors for developing pulmonary complications after surgery in semisitting position. An immediate intensive care treatment stabilizes rapidly the pulmonary situation and leads to good clinical outcomes.