Page 63 - CASA Bulletin 2022, 9(6) 增刊

Vol. 9, No 6, 2022

我喜欢在业余时间阅读名人传记文学，跑步，徒步旅行，和跳舞（交谊舞和拉丁舞）。疫情

后，打算与家人和朋友去亚洲和欧洲旅行。
5. 遇到过最有意思的病例？
复杂后路脊柱外科手术中的静脉空气栓塞 (venous air embolism, VAE) 一例。
The case was presented to ASA Annual Meeting as A
Medically Challenged Case. The Case Scenario as follows. We
anesthesiologists function as perioperative physicians and team
leaders while life threatening situation occurs.
About 20 years ago when I just became an attending
anesthesiologist, I was called to Operating Room emergently one
afternoon because a 65 y/o WF (her PMH significant for HTN,
DM 2, CAD, s/p stents 3 years prior to surgery, COPD and mild
pulmonary hypertension) undergoing 10-hr posterior spinal fusion
(PSF) & instrumentation on T3-sacrum suddenly developed low
blood pressure and ETCO2 levels. However, these vital signs
were back to normal ranges within one or two minutes. After
quickly ruled out mechanical and artificial factors, blood sample
was sent for ABG analysis for a possible venous air embolism
(VAE). This is a difficulty dilemma. I was wondering if I should
inform the surgeon, our Chief of Spine Surgery at Washington
University in St. Louis to stop the surgery right away. I was hesitating because the patient
probably just had a small VAE in which most of VAE are clinically transient and insignificant
during these kinds of PSF & Instrumentation surgeries. While waiting for ABG results, she
again dropped her blood pressure, oxygen saturation and ETCO2 levels, much worse than first
time. It indicated that she might be having a big VAE, or pulmonary embolus (PE), both life-
threatening conditions. Based on my knowledge, experience, and clinical observation: I told our
Chief, a prestigious and internationally known spine surgeon to stop the surgery immediately
without ABG and other test results available. Then we quickly turned the patient to the supine
position with surgical wound covered, initiated CPR and advanced cardiovascular life support
(ACLS) promptly after she was confirmed to be in PEA. In addition, cardiac surgeons and
additional anesthesia colleagues were summoned for help. Massive VAE confirmed by TEE.
Aspiration of air through RIJ central line attempted on her left lateral T-position but
unsuccessful.
We did our best but were, unfortunately, unable to save her life. We as a team subsequently
communicated with the patient’s family and regretted about their beloved loss, explained what
happened, and told them that we had done everything we could to try to save her life, and
finally expressed our deep condolences on the death of their beloved one. The patient’s family
completely understood even though they were initially shocked and very sad. In fact, they
greatly appreciated our immediate response to this catastrophic event, teamwork, and open
communication at the end.

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