• Franziska Günther, Paul Frank, Makoto Nakamura, Elvis Josef Hermann, and Thomas Palmaers.
• Department of Anaesthesiology and Intensive Care, Medical School Hannover (OE8050), Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
• Acta Neurochir (Wien). 2017 Feb 1; 159 (2): 339-346.

BackgroundThere is an ongoing debate about the sitting position (SP) in neurosurgical patients. The SP provides a number of advantages as well as severe complications such as commonly concerning venous air embolism (VAE). The best monitoring system for the detection of VAE is still controversial.MethodsIn this retrospective analysis we compared 208 patients. Transesophageal echocardiography (TEE) or transthoracic Doppler (TTD) were used as monitoring devices to detect VAE; 101 cases were monitored with TEE and 107 with TTD.ResultsThe overall incidence of VAE was 23% (TTD: 10%; TEE: 37%), but the incidence of clinically relevant VAE (drop in end-tidal carbon dioxide above 3 mmHg) was higher in the TTD group (9 out of 17 VAE, 53%) compared to the TEE group (19 out of 62 VAE, 31%). None of the patients with recorded VAE had clinically significant sequelae.ConclusionsIn this small sample we found more VAE events in the TEE group, but the incidence of clinically relevant VAE was rare and comparable to other data. There is no consensus in the definition of clinically relevant VAE.

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