Incidences of venous air embolism and patent foramen ovale among patients undergoing selective peripheral denervation in the sitting position

• Published in: Neurosurgery Vol. 53; no. 2; p. 316
• Main Authors: Girard, François, Ruel, Monique, McKenty, Sylvie, Boudreault, Daniel, Chouinard, Philippe, Todorov, Alexandre, Molina-Negro, Pedro, Bouvier, Guy
• Format: Journal Article
• Language: English
• Published: United States 01.08.2003
• Subjects: Adult; Aged; Denervation - adverse effects; Echocardiography, Transesophageal; Embolism, Air - diagnostic imaging; Embolism, Air - etiology; Embolism, Air - physiopathology; Female; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - diagnostic imaging; Heart Septal Defects, Atrial - physiopathology; Humans; Incidence; Male; Middle Aged; Peripheral Nerves - diagnostic imaging; Peripheral Nerves - physiopathology; Peripheral Nerves - surgery; Posture - physiology; Retrospective Studies; Severity of Illness Index; Torticollis - diagnostic imaging; Torticollis - physiopathology; Torticollis - surgery; Veins - diagnostic imaging; Veins - physiopathology; Veins - surgery
• ISSN: 0148-396X
• DOI: 10.1227/01.NEU.0000073529.40402.4E

The incidence and severity of venous air embolism (VAE), a potentially fatal complication, among patients undergoing selective peripheral denervation in the sitting position have never been clearly established. We designed this retrospective study to assess the incidence and severity of VAE, the incidence of paradoxical air embolism, and the occurrence of patent foramen ovale, as detected with transesophageal echocardiography, as well as the effects of its detection on patient treatment. After institutional review board approval, data were collected from the charts of all patients who underwent selective peripheral denervation at our institution between 1988 and 2001. The severity of VAE was assessed by using a 5-point scale. Data for 342 patients were available for analyses. Seven patients exhibited VAE, yielding an incidence of 2%. The severity of VAE was 2/5 for three patients, 3/5 for three patients, and 4/5 for one patient. Air could be aspirated from the central venous catheter for three patients. No deaths occurred. Among the 96 transesophageal echocardiographic examinations performed, 5 cases of patent foramen ovale were detected (5.2%). For those patients, surgery was performed in the prone or park-bench position. No paradoxical air embolism was detected. This is the first large study to directly assess the incidence and severity of VAE among patients undergoing selective peripheral denervation in the sitting position. We recommend that the detection of a patent foramen ovale prompt a change in position for this surgical procedure.