July 14, 1978

Atrial Catheter and Lumbar Disk Surgery

Author Affiliations

University of Pennsylvania School of Medicine Philadelphia

JAMA. 1978;240(2):110. doi:10.1001/jama.1978.03290020032012

To the Editor.—  Our group of neurosurgical anesthesiologists disagrees with the belief of Albin et al (239:496, 1978) that patients undergoing lumbar disk surgery in the knee-chest position should have a right atrial catheter placed preoperatively.Although the venous pressure at the lumbar incision is probably low and air embolism is a theoretic possibility, there is a conspicuous absence of reports of hemodynamically significant air embolism in patients undergoing this common operation. Albin et al refer to the case of Shenkin and Goldfedder (210:726, 1969) as an example of fatal air embolism occurring in a prone patient. However, that patient's operation was not a laminectomy but posterior-fossa exploration for an arteriovenous malformation. Furthermore, the air embolism occurred after hemorrhage and after the venous pressure was further lowered by ganglionic blockade in addition to head-up tilt and mechanical ventilation with a negative-pressure phase.We place a right atrial catheter and use