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Venous Air Embolism 





  • Air on TEE or change in doppler tone if monitoring

  • ↓ ETCO2

  • ↓ BP

  • ↓ SpO2

  • ↑ CVP

  • Bronchospasm

  • Dyspnea & respiratory distress or cough in awake patient 

  • Mill wheel murmur on cardiac auscultation (late sign)





  • Goals: prevent further entrainment of air, hemodynamic support, treat existing air 

  • Inform surgeon

  • Flood surgical field with saline & apply bone wax 

  • Supportive therapy:

    • ​100% oxygen, decrease or turn off volatile anesthetic

    • Stop nitrous oxide

    • IV fluid bolus

    • Vasopressors (epinephrine, norepinephrine, dobutamine)

  • Positioning:

    • Place surgical site below heart (if able)

    • Lower the head position & compress the jugular veins (if surgical site above the neck)

    • Reposition the patient into left lateral decubitus, trendelenberg, or left lateral decubitus head down position (controversial - poor evidence & often impractical to do in the OR)

  • Definitive therapy:

    • Hyperbaric oxygen therapy (especially if paradoxical air embolism) 

    • Aspirate air from the central catheter if in situ

    • Chest compressions

  • PEEP is of no value & increases risk of paradoxical air embolism

  • Consider TEE to assess air & RV function




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