Venous Air Embolism during Neuroendoscopy

Abstract

Sir, Among the various problems associated with neuroendoscopic surgery, venous air embolism (VAE) has not been described earlier. We report here the development of this complication during endoscopic removal of a third ventricular (TV) craniopharyngioma cyst in an adult male patient and hypothesise the probable causative mechanism. This patient was subjected to our routine anaesthesia & monitoring protocol and neuroendoscopic technique. Before the start of surgery, the patient's heart rate (HR) was 86 beats/min, invasive arterial blood pressure (ABP) was 114/72 mmHg, end-tidal carbon dioxide value (EtCO 2) was 33 mmHg and pulse oximetry value (SpO 2) was 99%. Excision of the TV cyst was begun with a rigid neuroendoscope aided by a slow infusion of the irrigating fluid. During surgery, profuse bleeding occurred from a torn septal vein, obscuring the surgical field. The rate of irrigation was stepped up, the egress port of the endoscope was occluded to tamponade the bleeding and cauterization was attempted. Suddenly, the patient's HR and ABP increased to 154 beats/min & 177/94 mmHg respectively, followed immediately by an abrupt fall in his EtCO