The incidence of venous air embolism during total hip arthroplasty

Bruce D. Spiess*, Marc S. Sloan, Robert J. McCarthy, Timothy R. Lubenow, Kenneth J. Tuman, Stephen D. Matz, Anthony D. Ivankovich

*Corresponding author for this work

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Venous air embolism has been reported to occur during total hip arthroplasty. The incidence of venous air embolism, however, has not been previously studied in a large series using Doppler ultrasound and mass spectrometry. Seventy patients undergoing total hip arthroplasty were monitored for venous air embolism with precordial Doppler ultrasound, central venous catheter, end-tidal N2 and CO2 (mass spectrometry), and arterial blood gases (ABG). Changes in the monitored variables consistent with venous air embolism were noted in 57% by Doppler ultrasound, 9% by mass spectrometry, 4% by central venous catheter and 3% of the cases by ABG. A total of 77 Doppler ultrasound events were detected in 40 of the 70 patients studied. Hemodynamic changes consisting of either hypotension, defined as a ≥20% decrease in mean arterial pressure (MAP), or cardiac dysrhythmia occurred during 43% of these events. The Doppler ultrasound was the only monitor that detected all cases of venous air embolism with concomitant hemodynamic changes. Air was aspirated from the central venous catheter during 10% of the detections of venous air embolism by Doppler ultrasound. Venous air embolism in total hip arthroplasty is a common event and may be responsible for hemodynamic changes previously ascribed to the use of methylmethacrylate cement. Routine monitoring with Doppler ultrasound appears warranted. The routine use of central venous catheterixation may also be warranted.

Original languageEnglish (US)
Pages (from-to)25-30
Number of pages6
JournalJournal of Clinical Anesthesia
Volume1
Issue number1
DOIs
StatePublished - 1988

Keywords

  • Doppler ultrasound
  • Embolism, air
  • arthroplasty, replacement, hip
  • blood gas monitoring, transcutaneous
  • central venous pressure
  • hemodynamics
  • mass spectrometry
  • methylmethacrylates

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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