title: Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants.
abstract: BACKGROUND
  Various studies have reported an incidence of venous air embolism (VAE) as high as 82.6% during surgical procedures for craniosynostosis. There has been an increase in the use of minimally invasive, endoseopie surgical procedures, including applications for endoscopic strip craniectomy. The current study prospectively evaluated the incidence of VAF during endoscopic strip craniectomy.
  
  
  METHODS
  Continuous, intraoperative monitoring for VAE was performed using precordial Doppler monitoring. A recording was made of the Doppler tones and later reviewed to verify its accuracy.
  
  
  RESULTS
  The cohort for the study included 50 consecutive neonates and infants ranging in age from 3.5 to 36 weeks and ranging in weight from 3 to 9 kg. Surgical time varied from 31 to 95 min for a total of 2,701 mm of operating time, during which precordial Doppler tones were auscultated. In 46 patients, there was no evidence of VAE. In four patients, there was a single episode of VAE. Two of the episodes of VAE were grade I (change in Doppler tones), and two were grade H (change in Doppler tones and decrease in end-tidal carbon dioxide). No grade III (decrease in systolic blood pressure by 20% from baseline) VAF was noted.
  
  
  CONCLUSIONS
  In addition to previously reported benefits of decreased blood loss, decreased surgical time, and improved postoperative recovery time, the authors noted a low incidence of VAF during endoscopic strip craniectomy in neonates and infants.
authors.affiliation: Department of Anesthesiology, The University of Missouri, Columbia 65212, USA. TobiasJ@health.missouri.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: J O
authors.initials: JO
authors.lastname: Johnson
authors.forename: D F
authors.initials: DF
authors.lastname: Jimenez
authors.forename: C M
authors.initials: CM
authors.lastname: Barone
authors.forename: D S
authors.initials: DS
authors.lastname: McBride
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D004618:Embolism, Air / Q000453:epidemiology / Q000209:etiology*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies