Acute pulmonary edema due to occult air embolism detected on an automated anesthesia record: illustrative case

Abstract

BACKGROUND The authors report a case of venous air embolism (VAE) during a pediatric posterior fossa craniotomy with resulting pulmonary edema requiring postoperative ventilation. Pulmonary edema is a known but rare complication of VAE, and diagnosis and treatment are discussed. OBSERVATIONS The embolism was undetected during the surgical procedure, and the first clinical sign of respiratory decompensation appeared an hour after the initial insult, with imaging suggesting acute pulmonary edema. A transient but significant end-tidal carbon dioxide decrease was detected on postoperative review of the anesthesiology record. LESSONS This report highlights an uncommon sequela of VAE and the importance of post hoc automated record review for intraoperative event analysis.