The anaesthetic management of posterior fossa explorations in infants

Venous air embolism in a child undergoing posterior fossa craniotomy: a case report

The incidence of venous air embolism in children undergoing neurosurgical procedures in the sitting position may be as high as 33 per cent. It may be more serious in children because smaller total volumes of air can produce serious physiologic disturbances or fatalities, and the risk of systemic air embolism through a patent foramen ovale or patent ductus arteriosus may be greater than in adults. The case of a six-year-old child who sustained four separate episodes of air embolism while undergoing posterior fossa exploration is presented. Early episodes were well tolerated, but later episodes produced clinical instability. A total of 11 cc of air was recovered from an indwelling right atrial catheter, and the patient recovered uneventfully. This case report illustrates the physiologic changes produced by venous air embolism and reviews the importance of adequate monitoring techniques and early treatment.