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August 7, 1967

Newer Considerations in Air Embolism During Operation

Author Affiliations

From the Department of Anesthesia, University Hospitals, University of Iowa, Iowa City.; Dr. Hamilton is editor of the Anesthesia Problem of the Month series.

JAMA. 1967;201(6):376-377. doi:10.1001/jama.1967.03130060050014

Providing anesthesia for patients who are in the sitting position presents problems of major magnitude. Circulatory insufficiency and air embolism are perhaps the most important of these. The latter has often been catastrophic in onset and consequence, but two recent developments demonstrated in the following case provide possible means of more successful management of this complication.

Report of a Case  A 56-year-old man was anesthetized for a suboccipital craniectomy to be performed with the patient in the sitting position. The anesthetic management consisted of intravenous induction with thiopental sodium followed by maintenance with halothane (Fluothane), nitrous oxide (3 liters/ min), and oxygen (2 liters/min). A 14-gauge, 24-inch plastic catheter, inserted into the right antecubital vein until only 6 inches of catheter were exposed externally, was connected to a strain gauge to monitor central venous pressure. Arterial blood pressure was similarly monitored via an indwelling arterial catheter. An esophageal stethoscope was