Venous air embolism (VAE) is a rare but severe complication that can occur during surgical procedures that involve the exposure of vascular structures or pressurized irrigation. We present a rare instance of severe VAE in a child that transpired during the irrigation of the bone marrow cavity during surgery for femoral osteomyelitis in a 3-year-old girl. The patient experienced a rapid clinical deterioration shortly after the commencement of irrigation with diluted povidone-iodine and saline. This deterioration was characterized by a sudden decrease in end-tidal carbon dioxide, oxygen saturation, pulse rate, and blood pressure. A bedside echocardiogram promptly confirmed the presence of intravascular air bubbles. Rapid symptom relief was achieved through prompt emergency interventions, which included catheter aspiration, 100% oxygen, left lateral positioning, and irrigation cessation. The patient underwent a full recovery without any neurological sequelae. In pediatric orthopedic surgery, the significance of vigilance, immediate echocardiographic assessment, and timely treatment to prevent morbidity and mortality due to VAE is underscored by this case.
Feng et al. (Fri,) studied this question.