An air embolism in the perioperative period is often unexpected and it can be life-threatening. It has been described with many types of surgical procedures. Identifying a patient as being at risk allows for rapid diagnosis and therapy.


Risk factors for a perioperative air embolism:

(1) surgical site >= 5 cm above the right atrium (heads up surgical position, other)

(2) presence of a pressure gradient that drives air into the vascular circulation

(2a) low central venous pressure (dehydration, shock, etc)

(2b) high pressure blood or fluid infusion

(2c) pressure at the operative field

(3) multiple large, noncompressed venous channels in the operative field

(4) insertion, removal or manipulation of a central venous catheter

(5) manipulation of other intravascular catheters (radial artery, hemodialysis, etc)


Surgical procedures at high risk for air embolism:

(1) neurosurgical procedures, especially if there is a breech in a dural sinus

(2) posterior fossa or neck surgery

(3) laparoscopy

(4) Cesarean section

(5) total hip arthroplasty


Surgical procedures with a moderate risk for air embolism:

(1) spinal fusion or cervical laminectomy

(2) radical prostatectomy

(3) gastrointestinal endoscopy, especially if there is a disruption of the mucosa

(4) coronary artery surgery


Almost any surgical procedure can result in an air embolism under the right conditions.


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