• Li-Hui Luo, Zhi-You Peng, Sheng-Mei Zhu, and Yong-Xing Yao.
• Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
• Medicine (Baltimore). 2018 Sep 1; 97 (39): e12639.

RationaleAlthough venous air embolism (VAE) during liver operation has been reported occasionally, fatal VAE in hepatic resection is uncommon. Prompt detection of VAE by transesophageal echocardiography (TEE) is crucial for effective therapy. We describe a case of fatal VAE that caused repeated cardiac arrest during hepatic resection and was confirmed by TEE.Patient ConcernsA 51-year-old woman with a body weight of 50 kg underwent partial liver resection due to intrahepatic duct calculus. She had a 1-year history of intrahepatic duct calculus without cardiopulmonary disease. The operation was performed under general anesthesia combined with epidural block. When the inferior vena cava was compressed, the PetCO2 level decreased abruptly from 30 to 10 mmHg, followed by a decrease in SpO2 and the development of hypotension. Her heart rate increased with ST interval elevation on electrocardiography monitoring. Ephedrine and phenylephrine were administered immediately but had little effect. Cardiac arrest occurred.DiagnosesAir embolism was detected by TEE.InterventionsResuscitation was successful although cardiac arrest occurred repeatedly.OutcomesThe patient returned to consciousness 6 hours postoperatively but died of multiorgan dysfunction 10 days later.LessonsFatal air embolism may happen during hepatic resection. Prompt detection of VAE by TEE is crucial for effective therapy and should always be available during hepatic resection.

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