開顱手術中反覆發作靜脈空氣栓塞－－病例報告

Repeated Attacks of Venous Air Embolism during Craniotomy-- A Case Report

開顱手術中發生靜脈空氣栓塞並不少見，卻鮮少手術中反覆發作之報告。我們在此報告一俯臥開顱手術中發生反覆性靜脈空氣栓塞之成功處理病例。有高血壓病史之七十歲男性病人，因右小腦半球出血合併瀕臨脫垂至腦幹之危險，故接受移除腦內血塊之緊急手術。手術進行中因突發性吐氣末端二氧化碳(EtC02)下降，中央靜脈壓上升，血壓下降，空氣氣泡由中央靜脈導管被抽出，故靜脈空氣栓塞被診斷出。因為適當的診斷和正確的治療，我們很成功地改善了病人的血行動力狀態，而且病人沒有留下任何後遺症地出院。早期發現並積極的治療是處理靜脈空氣栓塞的不二法門。

Venous air embolism (VAE) is not uncommon during craniotomy, but repeated attacks of VAE during a single surgical procedure is rarely seen. We report a successful intraoperative management of repeated attacks of air embolism in a patient who sustained craniotomy for intracranial hemorrhage (ICH) in prone position. A 70-year-old male suffering from hemorrhage in the right cerebellar hemisphere with impending brainstem herniation was scheduled for craniotomy. He had history of hypertension but it was not well controlled with medical treatment. Emergent craniotomy for removal of blood clot resulting from ICH was performed. During the operation, sudden decrease of end-tidal CO2 (EtCO2) level, fall of blood pressure and increase of central venous pressure (CVP) were noted. Since air bubbles were retrieved from CVP catheter venous air embolism was highly suspected. With prompt diagnosis and proper management, we successfully improved the patient's hemodynamic status and he was discharged without any sequelae. Early detection together with aggressive treatment is the only way in the management of intraoperative venous air embolism.