• J H Rice and R M Gonzalez.
• Department of Anesthesiology, Eye and Ear Hospital, University of Pittsburgh, PA 15213.
• J Clin Anesth. 1992 Jan 1; 4 (1): 21-4.

Study ObjectiveTo establish the frequency of large visible bubbles or collections of bubbles in the jugular vein during radical neck dissection in the supine position.DesignProspective observation by at least two investigators of random consecutive patients scheduled for radical neck surgery.SettingOperating room suite in a university hospital specializing in head and neck cancer surgery.PatientsTwelve consecutive ASA physical status II and III patients undergoing modified radical dissection for cancer.InterventionsGeneral anesthesia with fentanyl, oxygen (O2) 30% to 40%, nitrous oxide (N2O) 60% to 70%, and isoflurane 0.5% to 1.5%, with mechanical ventilation. Table position horizontal. Modified radical neck dissections performed by attending surgeons. Surgical field (jugular vein) carefully observed by the surgeons and an independent anesthesiologist investigator for the presence of bubbles during the dissection.Measurements And Main ResultsEasily visible bubbles were observed in the jugular veins of 42% (5 of 12) of the consecutive radical neck dissection patients studied. Some of the collections of bubbles were large (greater than 2.5 cm in diameter). In one case, the appearance and subsequent disappearance of bubbles was followed by a transient drop in arterial blood pressure (BP) and in end-tidal carbon dioxide (PETCO2), which was suggestive of a diagnosis of central venous air embolization.ConclusionsWe theorize that some unexplained, undesirable intraoperative events (hypotension, arrhythmia, and hypoxemia) during radical neck dissection could be a result of venous air embolus or paradoxical air embolus. The anesthesia community should be aware of the high frequency of these visible bubbles in the jugular veins during radical neck surgery, even in the supine position. At minimum, this phenomenon is a frequent event of intellectual interest. At worst, these bubbles may be harbingers of significant central air embolism.

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