Page 8 - CASA Bulletin of Anesthesiology 2022; 9(3)-1 (1)

CASA Bulletin of Anesthesiology

units of FFP and 2 packs of platelets. The total amount of vasoactive drugs were phenylephrine
60 mg, vasopressin 80 units and norepinephrine 4mg. A total of epinephrine 15mg, sodium
bicarbonate 200 ml. Insulin 20 units, 50% dextrose 100 ml and calcium chloride 6 grams in
divided doses were administered.

Discussion

Iatrogenic procedures are the main cause of vascular VAE. Perioperative VAE and cardiac
arrest have been reported during surgical and invasive procedures, especially the site is above the
2-3
level of right atrium (Table 1) . The morbidity and mortality as a result of VAE is directly
correlated with volume and rate of air entrainment and other risk factors (Table 2) 3-4, 13 .
Clinically, there are three types of air embolism based on different vascular systems (Table 3) .
13
Table 1. Surgical types and VAE

Relative risk Surgical procedures

Sitting position craniotomies
Posterior fossa surgery
High Laparoscopic procedures
Cesarean delivery
Central line placement

Prostatectomy
Medium Upper endoscopy
Blood cell transfusion
Spinal fusion/cervical laminectomy
Hepatic surgery
Low Burr hole neurosurgery
Peripheral nerve procedures
Vaginal procedures

Table 2. Factors related to the morbidity and mortality from VAE

Volume of air entrainment

Rate of accumulation of air
Size of the vascular lumen exposed to atmosphere

Low CVP and pressure gradient between surgical site and the right heart
Position of patient and height of vein with respect to the right side of heart

The distance of vein of entrainment to the right heart

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