Abstract
BACKGROUND: Venous air embolism (VAE) is a potentially fatal complication of craniotomy. When a TEE is not used, attention to waveform-level changes during conventional monitoring is crucial. CASE PRESENTATION: A woman in her 70 s underwent supratentorial tumor resection in the supine position with a slight head-up tilt. Approximately 1 h after the craniotomy, gradual decreases in SpO(2) (98% → 96%), systolic blood pressure (105 → 90 mmHg), and EtCO(2) (37 → 30 mmHg) were observed. New micro-oscillations appeared on the capnogram plateau, followed by an EtCO(2) decrease to 22 mm Hg. VAE was suspected. Treatment, including field flooding, head-down positioning, as well as FiO(2), dobutamine, and rapid fluid supplementation, stabilized her and allowed the uneventful completion of surgery. Arterial blood gas levels improved concurrently with EtCO(2) recovery. CONCLUSIONS: Careful scrutiny of capnogram morphology, not only numeric EtCO(2), can expedite the suspicion and timely management of VAE when advanced monitoring is unavailable.