title: Incidences of venous air embolism and patent foramen ovale among patients undergoing selective peripheral denervation in the sitting position.
abstract: OBJECTIVE
  The incidence and severity of venous air embolism (VAE), a potentially fatal complication, among patients undergoing selective peripheral denervation in the sitting position have never been clearly established. We designed this retrospective study to assess the incidence and severity of VAE, the incidence of paradoxical air embolism, and the occurrence of patent foramen ovale, as detected with transesophageal echocardiography, as well as the effects of its detection on patient treatment.
  
  
  METHODS
  After institutional review board approval, data were collected from the charts of all patients who underwent selective peripheral denervation at our institution between 1988 and 2001. The severity of VAE was assessed by using a 5-point scale.
  
  
  RESULTS
  Data for 342 patients were available for analyses. Seven patients exhibited VAE, yielding an incidence of 2%. The severity of VAE was 2/5 for three patients, 3/5 for three patients, and 4/5 for one patient. Air could be aspirated from the central venous catheter for three patients. No deaths occurred. Among the 96 transesophageal echocardiographic examinations performed, 5 cases of patent foramen ovale were detected (5.2%). For those patients, surgery was performed in the prone or park-bench position. No paradoxical air embolism was detected.
  
  
  CONCLUSIONS
  This is the first large study to directly assess the incidence and severity of VAE among patients undergoing selective peripheral denervation in the sitting position. We recommend that the detection of a patent foramen ovale prompt a change in position for this surgical procedure.
authors.affiliation: Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada. francois.girard.chum@ssss.gouv.qc.ca
authors.forename: François
authors.initials: F
authors.lastname: Girard
authors.forename: Monique
authors.initials: M
authors.lastname: Ruel
authors.forename: Sylvie
authors.initials: S
authors.lastname: McKenty
authors.forename: Daniel
authors.initials: D
authors.lastname: Boudreault
authors.forename: Philippe
authors.initials: P
authors.lastname: Chouinard
authors.forename: Alexandre
authors.initials: A
authors.lastname: Todorov
authors.forename: Pedro
authors.initials: P
authors.lastname: Molina-Negro
authors.forename: Guy
authors.initials: G
authors.lastname: Bouvier
mesh_terms: D000328:Adult; D000368:Aged; D003714:Denervation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010525:Peripheral Nerves / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D011187:Posture / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014103:Torticollis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery