Yonsei Med J.  2013 Jan;54(1):209-214. 10.3349/ymj.2013.54.1.209.

Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position

• An J
• Shin SK
• Kwon JY
• Kim KJ

• KMID: 1776940
• DOI: http://doi.org/10.3349/ymj.2013.54.1.209

Abstract

PURPOSE
Venous air embolism (VAE) is characterized by the entrainment of air or exogenous gases from broken venous vasculature into the central venous system. No study exists regarding the effect of patient positioning on the incidence of VAE during abdominal myomectomy. The purpose of this study was to assess the incidence and grade of VAE during abdominal myomectomy in the supine position in comparison to those in the head-up tilt position using transesophageal echocardiography.
MATERIALS AND METHODS
In this study, 84 female patients of American Society of Anesthesiologist physical status I or II who were scheduled for myomectomy under general anesthesia were included. Patients were randomly divided into two groups: supine group and head-up tilt group. Transesophageal echocardiography images were videotaped throughout the surgery. The tapes were then reviewed for VAE grading.
RESULTS
In the supine group, 10% of the patients showed no VAE. Moreover, 10% of the patients were classified as grade I VAE, while 50% were categorized as grade II, 22.5% as grade III, and 7.5% as grade IV. In the head-up tilt group, no VAE was detected in 43.2% of the patients. In addition, 18.2% of the patients were classified as grade I VAE, 31.8% as grade II, and 6.8% as grade III; no patients showed grade IV. VAE grade in the head-up tilt group was significantly lower than that in the supine group (p<0.001).
CONCLUSION
The incidence and grade of VAE in the head-up tilt group were significantly lower than those in the supine group during abdominal myomectomy.

Keyword

Venous air embolism; myomectomy; head-up tilt

MeSH Terms

Abdomen/pathology
Adult
Echocardiography, Transesophageal
Embolism, Air/epidemiology/*etiology
Female
Humans
Incidence
Middle Aged
Myoma/pathology/*surgery
*Posture
Supine Position
Uterine Myomectomy/adverse effects/*methods
Uterus/pathology/ultrasonography
Veins/*ultrasonography

Figure

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  Fig. 1 Externalization of the uterus for excision of a mass of myoma. M, mass of myoma.

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  Fig. 2 Flow diagram.

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  Fig. 3 Venous air emboli detected by transesophageal echocardiography during myomectomy. (A) Mid-esophageal four-chamber view. (B) Bicaval view. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle; IVC, inferior vena cava.

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