Acute pulmonary edema due to occult air embolism detected on an automated anesthesia record: illustrative case

BACKGROUND: The authors report a case of venous air embolism (VAE) during a pediatric posterior fossa craniotomy with resulting pulmonary edema requiring postoperative ventilation. Pulmonary edema is a known but rare complication of VAE, and diagnosis and treatment are discussed. OBSERVATIONS: The embolism was undetected during the surgical procedure, and the first clinical sign of respiratory decompensation appeared an hour after the initial insult, with imaging suggesting acute pulmonary edema. A transient but significant end-tidal carbon dioxide decrease was detected on postoperative review of the anesthesiology record. LESSONS: This report highlights an uncommon sequela of VAE and the importance of post hoc automated record review for intraoperative event analysis.