Venous air embolism during stifle arthroscopy in a horse

This case report describes venous air embolism as a complication of stifle joint arthroscopy in a 16-year-old French Saddle Pony. Carbon dioxide was used to achieve joint distension during the procedure and accidentally entered the vasculature, causing the embolism. The diagnosis was based on a sudden onset of laboured breathing, tachycardia and dropping end-tidal carbon dioxide (PE’CO2) and was confirmed by arterial blood gas analysis showing hypercapnia and large PE’CO2—arterial partial pressure of carbon dioxide (PaCO2) difference. This complication was treated by increasing the fraction of inspired oxygen (FIO2) and immediate ceasing of further gas insufflation. The horse suffered no further complications. To our knowledge, this is the first publication reporting this complication during arthroscopy in a horse. Awareness of this complication should be raised between veterinarians performing arthroscopies when using gas as the distending agent. A high index of suspicion and early recognition of the embolism can improve chances for full and unremarkable recoveries.