Abstract :
A one year 3 month old child undergoing fronto-orbital advancement surgery for metopic craniosynostosis had severe bleeding when the surgeon attempted to remove bone flap. Head-end elevation was given at the surgeon’s request to reduce bleeding. Immediately there was a drastic fall in end tidal carbon dioxide (ETCO2) and arterial saturation (SpO2). Considering air embolism, fraction of inspired oxygen (FiO2) was increased to 100% and the surgeon filled the field with saline and covered the area with wet gauze. The operating table was leveled. The child continued to deteriorate with the cardiac rhythm changing to pulseless electrical activity and asystole. Incremental bolus doses of adrenaline, blood products transfusion, fluid bolus and infusion of inotropes were given. Chest compression was not done as the endotracheal tube was fixed to the chest of the patient. Tube dislodgement without access to the head-end of the patient would have been a disaster. The child became hemodynamically stable, the surgery continued and the child was extubated the next day. Other than focal seizures which responded to levetiracetam, the child had no
neurological deficits.
Keyword :
Air embolism, Cardiac arrest, Craniosynostosis, Pulseless electrical activity.