1. Venous Air Embolism in the Operating Room Susan Medina RN, BSN, SRNA

2. Objectives Review case reports related to venous air embolism (VAE) Discuss the history behind the discovery of VAE Examine factors and physiologic pathways associated with VAE Identify clinical manifestations that may be observed in the presence of VAE Discuss diagnosis, prevention and treatment of venous air embolism

3. A Case Report…A Venous Air Embolism During Lumbar Laminectomy in the Prone Position

5. Jean Zulema Amussat

6. Nicholas Senn, M.D., Ph.D.

8.  Right heart full of air bubbles  No air seen in the left atrium Venous Air Embolism

9. Factors Associated with Venous Air Embolism  Volume of air entrainment  Rate of accumulation  Position of the patient  2 00 to 300 mL or 3 to 5 mL/kg have been reported to be FATAL

10. Exposure of Pathophysiologic Pathways  Micro air emboli  Interaction between air and blood  Gas air-lock scenario

11. Paradoxical Air Embolism

13. EKG Changes

14. How Does VAE Affect End Tidal CO 2 and Cardiac Output? http://www.capnography.com/new/52- capnograms/capno-quiz?start=5

17. Risk Factors for VAE Elevated positioning of the wound in relationship to the heart Numerous large, noncompressed venous channels in the surgical field Lateral decubitus position Trendelenburg position High degree of vascularity Exposure of the uterus Open vascular channels

20. “The cornerstone for diagnosis of venous air embolism is simply a high index of suspicion”

21. Table 5. The Management of VAE  Inform the surgeon  Adequate hydration  Prevent further gas entry  Flood the surgical field  Evaluate and remove the origin of gas entry  Increase right atrial pressure and trap the air in right atrium  Reverse trendelenburg position if possible  Left lateral recumbent position  Discontinue N 2 O and ventilate with 100% oxygen  Central venous catheterization proper position for aspiration of air  Resuscitation  Fluid administration  Drugs  Inotropes  Vasopressor  Vasodilator specific to pulmonary circulation  Cardiopulmonary resuscitation  Hyperbaric oxygen therapy