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Acta Neurochir (Wien) (2007) 149: 11771178 DOI 10.1007/s00701-007-1286-yPrinted in The Netherlands
Brief Report of Special CasePulmonary oedema following venous air embolism during transsphenoidal pituitary surgery
R. Arora, D. Chablani, G. P. Rath, H. Prabhakar
Neurosciences Centre, Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
Received 2 April 2007; Accepted 14 August 2007; Published online 4 September 2007 # Springer-Verlag 2007
Summary
Venous air embolism (VAE) is a well known complication in procedures where the operative eld is above the level of the heart. Acute pulmonary oedema after a large air embolus occurring during neurosurgery is also a recognized phenomenon. However, pulmonary oedema following repeated episodes of VAE in sublabial transsphenoidal (SLTS) surgery for pituitary adenoma has never been reported. We describe a case of VAE in a 65 year old male undergoing SLTS surgery for pituitary adenoma. Following this, the patient had pulmonary oedema which resolved on supportive treatment. Pulmonary oedema as a result of VAE may go unrecognised intraoperatively but can lead to a signicant postoperative morbidity. Early suspicion and recognition of VAE and institution of aggressive treatment will help to avoid fatal consequences.
Keywords: Transsphenoidal pituitary surgery; supine position; air embolism; pulmonary oedema.
Introduction
Doppler ultrasonic cardiac monitoring of patients undergoing transnasal transsphenoidal (TNTS) pituitary surgery in the semi-sitting position has revealed the occurrence of venous air embolism [3]. Our Literature
search did not reveal any report of non-cardiogenic pulmonary oedema following venous air embolism during surgery for pituitary tumors.
Case history
Our...