Venous air embolism during anesthesia for maxillary sinus irrigation: a case study.

In this case report, the authors describe the occurrence of venous air embolism during nasal irrigation following an adenoidectomy. A literature review is presented of surgical procedures in which venous air embolism has been documented. The means of diagnosis, the pathophysiology, and the recommended treatment of venous air embolus also are presented. The clinical signs and symptoms of air embolism are often nonspecific. Because of this, the importance of knowing the patient's history and the clinical settings in which air embolism can occur cannot be overemphasized. Air embolism may mimic an acute myocardial infarction or a cere-bral vascular accident, and unless one thinks "air embolism," the diagnosis may be missed. 1 Air may enter the systemic veins in sufficient quantity to produce serious embolic manifestations under a number of circumstances. These may be summarized as follows: 2 A. Surgical 1. Operations involving veins of the neck 2. Operations involving dural sinuses 3. Uterine curettage B. Diagnostic air injections 1. Into the perirenal area-(Diagnosis of adrenal tumors) 2. Into the peritoneal cavity a. Direct b. Transuterine-(When comparing the veins of the body, the uterine sinuses are probably the most vulnerable to the entrance of air) 3. Into the urinary bladder 4. Into the joints C. Therapeutic air injections 1. Maxillary sinus lavage 2. Pneumoperitoneum 3. Vaginal insufflation D. Obstetrical 1. During delivery of patients with pla-centa previa and abortion E. Accidental entrance of air into the intravenous apparatus Venous air embolism can be produced any time air is forced into the body deliberately. Any therapeutic or operative procedure about the head and neck which affords the possibility of air entering a vein has the potential of being extremely dangerous. Death has occurred during lavage of the nasal sinuses, 5 7 , 8 during tracheostomy, and during thyroidectomy. The focus of this article is to present a situation in which air embolism was not recognized immediately. The patho-physiology, means of early diagnosis, and recommended treatment of air embolism will be reviewed.