Girard François, Ruel Monique, McKenty Sylvie, Boudreault Daniel, Chouinard Philippe, Todorov Alexandre, Molina-Negro Pedro, Bouvier Guy
Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
Neurosurgery. 2003 Aug;53(2):316-9; discussion 319-20. 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.
静脉空气栓塞（VAE）是一种潜在的致命并发症，在接受坐位选择性周围神经去神经支配术的患者中，其发生率和严重程度尚未明确确定。我们设计了这项回顾性研究，以评估经食管超声心动图检测到的VAE的发生率和严重程度、反常空气栓塞的发生率、卵圆孔未闭的情况，以及其检测对患者治疗的影响。
经机构审查委员会批准后，收集了1988年至2001年间在本机构接受选择性周围神经去神经支配术的所有患者病历中的数据。使用5分制评估VAE的严重程度。
有342例患者的数据可供分析。7例患者出现VAE，发生率为2%。3例患者的VAE严重程度为2/5，3例患者为3/5，1例患者为4/5。3例患者可从中心静脉导管抽出空气。无死亡病例发生。在进行的96次经食管超声心动图检查中，检测到5例卵圆孔未闭（5.2%）。对于这些患者，手术在俯卧位或公园长椅位进行。未检测到反常空气栓塞。
这是第一项直接评估接受坐位选择性周围神经去神经支配术患者中VAE发生率和严重程度的大型研究。我们建议，检测到卵圆孔未闭时应改变该手术的体位。
