Key result
Venous air embolism occurred in 27.4% of patients operated on in the sitting position compared to 0% of patients operated on in a nonsitting position.
Why the study?
Does preoperative contrast echocardiography identify right-to-left shunts to prevent paradoxical air embolism in patients undergoing neurosurgery in the sitting position?
Observational (n=301)
Does preoperative contrast echocardiography identify right-to-left shunts to prevent paradoxical air embolism in patients undergoing neurosurgery in the sitting position?
Absolute Event Rate: 27.4% vs 0%
Preoperative contrast echocardiography effectively identifies right-to-left shunts (present in ~25% of patients), indicating that the sitting position should be avoided in these individuals to reduce the risk of paradoxical air embolism during neurosurgery.
Preoperative PFO screening may warrant consideration in sitting-position neurosurgery; leaves open whether detection improves embolism outcomes.
A persisting foramen ovale (PFO) is the most common cause of paradoxical air embolism. To detect right-to-left shunting, transthoracic contrast echocardiography was performed preoperatively in 301 patients scheduled for neurosurgical procedures in the sitting position. Echocardiography yielded evaluable results in 285 patients (94.7%). In 72 of 285 patients (25.2%), a PFO was diagnosed on the basis of contrast echo signals appearing in the left atrium or ventricle within 5 heart cycles after application of contrast medium via a peripheral vein. If echo signals appeared in the left heart after more than 5 heart cycles, an intrapulmonary right-to-left shunt was considered (11 patients, 3.9%). Venous air embolism (VAE) occurred in 27.4% of 226 patients operated on in the sitting position and in none of the 59 patients operated on in a nonsitting position. We conclude that the sitting position during neurosurgery should be avoided in patients with preoperative evidence of a right-to-left shunt at contrast echocardiography to reduce the risk of paradoxical air embolism (PAE).
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Schwarz et al. (1994) conducted an observational in Patients scheduled for neurosurgical procedures (n=301). Sitting position during neurosurgery vs. Nonsitting position was evaluated on Venous air embolism (VAE). Venous air embolism occurred in 27.4% of patients operated on in the sitting position compared to 0% of patients operated on in a nonsitting position.
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