Venous gas embolisms

: The risk of creating a venous gas embolism (VGE) exists, whenever surgery is performed in areas where venous pressures are below atmospheric pressure, or when the pressure of an insufflation gas exceeds venous pressures. Anaesthesia using N2O should be avoided in these situations. The patients should be monitored by systems offering sensitivity and specificity: Doppler, ECHO, ETCO2 and PAP-measurements are the methods providing the highest sensitivities. ETCO2 monitoring is recommendable. In addition, attention should be directed towards common clinical signs: Tachypnoea, tachycardia, systemic hypotension, cardiac arrhythmias and cardiac "mill wheel" murmurs. When a diagnosis of VGE is made, further embolization must be avoided. Let the patient inhale pure oxygen. Attempt to aspirate gas through a central venous line. Put the patient in a combined Durant's and Trendelenburg's position. (During caesarean section however, use the anti-Trendelenburg's position.) Consider hyperbaric oxygen treatment in case of arterial gas embolism.