Air Embolism in Sitting Position during Neurosurgical Operations and It’s Prevention: A Narrative Review

  • Zahid Hussain Khan
  • Shahram Samadi
  • Amir Poya Zanjani
  • Bassim Mohammed Hatemi
Keywords: Vascular air embolism; Venous air embolism; Paradoxical air embolism; Sitting position; Neuroanesthesia


Venous air embolism (VAE) is an entrapment of air or exogenously delivered gas from the operative field or the communicated environment into the venous system due to gradient pressure. VAE and paradoxical air embolism (PAE) are potentially serious neurosurgical complications and carry high neurologic, respiratory, and cardiovascular morbidity or even may be fatal. Some procedures are at risk of developing these conditions, but the sitting and semi-sitting positions represent a higher risk. It’s occurrence during anesthesia is challenging to the anesthesiologists in terms of early discovery and management. Anesthesiologist can play an important role in detection and urgent treatment of VAE in case of occurrence. If the sitting position is needed for a neurosurgical necessity it can be used with vigilant follow up throughout the procedure to detect any occurrence of VAE.