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Article: Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach
- Article from:
- Anaesthesia and Intensive Care
- Article date:
- June 1, 2005
- Author:
CopyrightCopyright Australian Society of Anaesthetists Jun 2005. Provided by ProQuest LLC. (Hide copyright information)
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SUMMARY
Neurosurgery in the sitting position offers advantages for certain operations. However, the approach is associated with potential complications, in particular venous air embolism. As the venous pressure at wound level is usually negative, air can be entrained. This air may follow any of four pathways. Most commonly it passes through the right heart into the pulmonary circulation, diffuses through the alveolar-capillary membrane and appears in expelled gas. It may pass through a pulmonary-systemic shunt such as a probe patent foramen ovale (paradoxical air embolism); it may collect at the superior vena cava-right atrial junction. Rarely it may traverse through lung capillaries into ...