Article
Is there an increased risk for air embolism in the semisitting position in patients with poor preoperative ASA grades?
Ist das Risiko für eine Luftembolie in halbsitzender Position bei Patienten mit schlechten ASA scores erhöht?
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Authors
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Hesham Elkayekh
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Shadi Al-Afif
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Mazin Omer
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Dirk Scheinichen
- Medizinische Hochschule Hannover, Anästhesie, Hannover, Deutschland
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Thomas Palmaers
- Medizinische Hochschule Hannover, Anästhesie, Hannover, Deutschland
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Elvis J. Hermann
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Joachim Kurt Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Many neurosurgical centers use the semisitting position in the surgery of various pathologies of the posterior cranial fossa. Despite of the many advantages of the semisitting position, venous air embolism represents possibly serious complication. We here examine, if patients with poor preoperative ASA grades have a higher risk for venous air embolism.
Methods: Over a 14-year period a total of 740 patients with various pathologies were operated on in the semi-sitting position. The perioperative clinical, surgical and anestheiogical data were collected to identify risk factors for the occurrence of venous air embolism. For this study, patients were dichotomized according to their preoperative American Society of Anesthesiologists (ASA) grade: Group A (ASA I + II), patients with no or mild previous illnesses. Group B (III + IV), patients with relevant previous illness.
Results: There were 404 women and 336 men. Mean age at surgery was 49 years (range 1-87 years). The medical condition according to ASA was classified as grade I =265 (35.8%), II=349 (47.2%) III=123 (16.6%) an IV=3 (0,4%). Venous air embolism was detected in 119 patients (16.1%) by Doppler/TEE. Twenty-three patients with VAE have a decrease of PtCO2 18 patients a drop in systolic blood pressure in and 23 patients had a combined drop in PtCO2 and systolic blood pressure. The following preoperative factors had no effect on the incidence of venous air embolism: hemoglobin value, BMI, body weight, height, gender and previous illnesses (arterial hypertension, heart disease). Surprisingly, there was a masked trend (P = 0.0532) however, that air embolism was less frequent in group B.
Conclusion: An unexpected result in our study was that in patients with a poorer preoperative physical condition (III and IV according to ASA classification) venous air embolism occurred less frequently. It is possible that ntraoperative surgical anestheisological measure were done with greater vigilance and attention in this group of patients.
