Lisa W. Faberowski

Incidence of venous air embolism during craniectomy for craniosynostosis repair.

Background Investigations to determine the incidence of venous air embolism in children undergoing craniectomy for craniosynostosis repair have been limited, although venous air embolism has been suspected as the cause of hemodynamic instability and sometimes death. A precordial Doppler ultrasonic probe is an accepted method for detection of venous air embolism and is readily available at most institutions. Methods A prospective study was conducted using a precordial Doppler ultrasonic probe in children undergoing craniectomy for craniosynostosis repair. The Doppler signal was continuously monitored intraoperatively for characteristic changes of venous air embolism. A recording was made of the precordial Doppler probe pulses, which was later reviewed by a neuroanesthesiologist, blinded to the intraoperative events. This information was correlated with the intraoperative events and episodes of venous air embolism were graded. Results Twenty-three patients were enrolled in the study during the 2-yr study period. Nineteen patients (82.6%) demonstrated 64 episodes of venous air embolism; six patients (31.6%) had hypotension associated with venous air embolism. Thirty-two episodes of hypotension were demonstrated in eight patients (34.7%). None of the patients developed cardiovascular collapse. Conclusion The incidence of venous air embolism in our study of 23 children undergoing craniectomy for craniosynostosis was 82.6%. Though most episodes of venous air embolism during craniosynostosis repair are without hemodynamic consequences, the preemptive placement of a precordial Doppler ultrasonic probe is a noninvasive, economic, and safe method for the detection of venous air embolism. Prompt recognition may allow for the early initiation of therapy, thereby decreasing morbidity and mortality rates related to venous air embolism.

Somatosensory-Evoked Potentials During Aortic Coarctation Repair

OBJECTIVE To determine the incidence of somatosensory-evoked potential (SSEP) changes and the interventions based on these changes during aortic coarctation repair. DESIGN Retrospective review. SETTING Single-institution, university hospital. PARTICIPANTS Eighty-four children who had undergone surgical repair of aortic coarctation from January 1984 to May 1996. INTERVENTIONS SSEPs were monitored in all patients throughout the procedure. A persistent decrease in amplitude greater than 50% from baseline was considered significant. Duration of SSEP changes in relation to the time course of surgical repair and whether a surgical or anesthetic intervention resulted from a change in SSEPs were documented. MEASUREMENTS AND MAIN RESULTS Eighty-four patients underwent 87 surgical procedures. SSEP changes occurred in 40% of the procedures: 38.5% with repair and 15% with test clamp, with 9% occurring during both test clamp and repair. Interventions, which included repositioning the aortic cross-clamp, elevating blood pressure, and aborting surgery, occurred in 26.4% of all procedures based on SSEP changes. No patient sustained a neurologic deficit. CONCLUSION This is the largest series to date describing the use of SSEPs in aortic coarctation repair. These SSEP changes were often immediately amenable to changes in surgical and anesthetic management. SSEP changes and interventions based on these changes occurred with a considerable frequency.

Intraoperative cardiac arrest in a neurosurgical patient: what are the options?

Intraoperative cardiac arrest is uncommon. We describe a case of intraoperative cardiac arrest in a patient undergoing anesthesia for surgical repair of an intracranial arteriovenous malformation (AVM).

Spinal Anesthesia for Nonpulmonary Surgery in a Lung Transplant Recipient

The anesthetic implications for patients requiring anesthesia for surgery after lung transplantation have not been thoroughly studied. The use of spinal anesthesia in patients undergoing lumbar laminectomy has been well described. This case demonstrates the use of spinal anesthesia for lumbar laminectomy in a patient who had previously undergone a bilateral lung transplantation. Spinal anesthesia was used to minimize the risk of respiratory complications such as aspiration, atelectasis, and pneumonia that may be associated with administration of a general anesthetic.