Letters to the Editor

Air Embolism During Spine Surgery in the Prone Position

To The Editor:

In 1995 we set up a registry1 for reporting cases of venous air embolism (VAE) during spine procedures in the prone position. A recent case report also containing a literature review2 revealed the existence of 20 cases of VAE as well as paradoxical air embolism (PAE) during spine procedures in the prone position in both adults and children. Surprisingly, 11 of the 20 died, with 8 of the deceased being pediatric patients. Our registry noted 9 probable cases of VAE/PAE with 8 deaths in the prone position during spine surgery probably due to VAE and/or PAE.3 My concern is that we are but seeing the tip of the proverbial iceberg in terms of the incidence of VAE-PAE in the prone position during spine procedures. With this in mind, I would appreciate hearing from anyone who believes he or she might have encountered a clinical problem where VAE/PAE during a spine procedure in the prone position might have been a distinct possibility. My contact e-mail is MALBIN@BHAM.RR.COM.

Maurice S. Albin, MD, MSc (Anes.)
Birmingham, AL

References

1. Albin MS, Ritter RR, Sloan T, et al. Central registry for venous air embolism. Anesth Analg 1995;81:658.
2. Wills J, Schwend RM, Paterson A, Albin MS. Intraoperative visible bubbling of air may be the first sign of venous air embolism during posterior surgery for scoliosis. Spine 2005;30:E629-35.
3. Personal Communication from Lorri A. Lee, MD, ASA Closed Claims Project, with permission from the ASA Closed Claims Committee to publish these data.