Zator powietrzny u chorych poddanych operacji w obrębie tylnego dołu czaszkowego w pozycji siedzącej

Konstancja Grzybowska¹, Izabela Duda¹, Stanisław Kwiek², Jerzy Luszawski², Anna Dyaczyńska-Herman¹, Ewa Karpel¹

Summary
Background. The purpose of the study was to assess the effects of various anaesthetic techniques and PEEP on the frequency of air embolism episodes during neurosurgical operations performed in the sitting position. Methods. 200 ASA I-III adult patients of both sexes, aged 17-65 years, scheduled for posterior fossa craniectomy in the sitting position were allocated to two groups to receive either propofol-based TIVA or isoflurane inhalation anaesthesia. Patients of both groups were also randomized to receive 9 cm H₂ O PEEP 5 minutes before the start of surgery. Intraoperatively, a sudden and sustained decrease in end-tidal carbon dioxide tension of> 5 mm Hg (0.67 kPa) was presumed to be due to venous air embolism. Results. Capnometry detected a 14% incidence of air embolism, which was not related to anaesthetic technique. 41% of embolism events occurred during craniotomy, and 52% during preparation of a tumour in the cerebello-pontine angle. Clinical signs were observed in 8 cases and only when there was a sudden and sustained E_T CO₂ decrease by more than 10 mmHg (1.3 kPa). PEEP did not prevent these events. Conclusions. Air embolism detected by capnometry is not always accompanied by hypotension or cardiovascular collapse. PEEP and the described anaesthetic protocols did not influence the frequency of air embolism events.

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