• Adriana Hervías, Ricard Valero, Paola Hurtado, Isabel Gracia, Laura Perelló, Francisco Javier Tercero, José Juan González, and Neus Fàbregas.
• Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España.
• Neurocirugia. 2014 May 1;25(3):108-15.

IntroductionEarly detection of venous air embolism (VAE) during neurosurgical procedures in sitting position decreases the severity of its complications.Objectivesour aim was to analyse the detection of VAE and its impact on patients operated in a sitting position, verify air aspiration through a central venous catheter and assess the feasibility of the routine use of transcranial Doppler (TCD) for intraoperative diagnosis of patent foramen ovale (PFO).Material And MethodsWe performed a prospective study of consecutive neurosurgical procedures performed in the sitting position for 5 years. Precordial Doppler and end-tidal carbon dioxide were the diagnostic methods for VAE. PFO was explored by TCD after anaesthetic induction.Results136 patients were operated in the sitting position, 93 craniotomies and 43 cervical spine procedures. Twenty-two patients (16.2%) were diagnosed with VAE (21.5% of craniotomies and 4.7% of spinal surgeries; p=.013). In 59% of cases, air was aspirated through the central venous catheter. There was haemodynamic involvement in 3 patients, impaired oxygenation in 4 and clinically relevant pneumocephalus in 5 of them. Two patients (1.4%) were diagnosed with PFO, but did not present episodes of VAE or paradoxical air embolism.ConclusionsThe series analysed confirmed a higher incidence of VAE in craniotomies than in cervical spine surgery in a sitting position. We were able to aspirate air through the central venous catheter in more than half the cases. No patients suffered critical intraoperative complications following our approach. The low incidence of PFO detected with TCD will imply a modification of our protocol performed on anaesthetised patients.Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

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