ACUTE PULMONARY-EDEMA AFTER LOW-LEVEL AIR-EMBOLISM DURING CRANIOTOMY - CASE-REPORT

Acute pulmonary edema after a large air embolus occurring during neuro surgery is a recognized phenomenon. The authors describe the course of a 76-year-old man who presented with noncardiogenic pulmonary edema s hortly after undergoing resection of a high convexity meningioma. Tran sthoracic Doppler sonography, however, showed no evidence of a large i ntraoperative emboli; the evidence for ongoing but low-magnitude air e mbolus included visualization of bone aspiration of irrigant before bo ne-edge waxing, transient intraoperative declines in end-tidal CO2 ten sion, and an increase of the fraction of inspired oxygen to maintain a dequate saturation after removal of the craniotomy flap. There was no hemodynamic instability noted. The airspace disease was self-limited a nd resolved on supportive treatment after approximately 1 week, as wou ld be expected for pulmonary edema caused by a single large intravenou s air embolus. The authors present this case as the first report of pu lmonary edema resulting from low-level air embolus occurring during cr aniotomy. This situation may go unrecognized intraoperatively but can cause the same significant postoperative morbidity as larger, more eas ily identified air emboli.