Successful management of venous air embolism with inotropic support.

PURPOSE: Since venous air embolism may occur during many different types of surgery, management of this clinical emergency can be required in patients who do not have a previously established central venous access for aspiration of air. Recent reviews suggest that management of right heart syndromes in patients with embolism is critical in improving outcome.

CLINICAL FEATURES: Abrupt decreases in oxygen saturation (from 98% to 40%) and end-tidal carbon dioxide tension (from 24 to 6 mm Hg), compatible with venous air embolism were observed in a 73-yr-old woman during craniotomy for meningioma in the supine position. Since no access for aspiration of air was readily available, therapy was directed at inotropic support of the right heart using a bolus of ephedrine. Cardiorespiratory variables rapidly returned to normal, and the patient recovered from anesthesia and surgery without sequelae.

CONCLUSIONS: Venous air embolism places an acute load on the right ventricle and may provoke right heart failure, even in the absence of total cardiovascular collapse. Treatment that supports right heart function may allow sufficient time for redistribution of embolized air and produce a good outcome when access for central aspiration of air is not available.