When air embolism is suspected during surgery in the sitting position, what is the first action to take?

When air embolism is suspected during surgery in the sitting position, what is the first action to take?

• A. Flood the surgical field with saline
• B. Discontinue N2O
• C. Apply jugular venous pressure
• D. Give 100% oxygen

Answer: (A)

The immediate priority is to stop ongoing air entry into the venous system. In a sitting-position surgery, venous air embolism can occur when open veins entrain air due to negative intrathoracic pressure. Flooding the surgical field with saline provides a rapid, mechanical barrier that prevents air from entering the veins and helps seal exposed bone surfaces with bone wax if needed. This quick field control buys time to implement other life-support measures, such as giving 100% oxygen and stopping nitrous oxide, and to position the patient to trap any air in the right heart. While turning toward left lateral decubitus with slight head-down and administering high-flow oxygen are critical steps, they follow the immediate field-occlusion action of saline flooding.

The immediate priority is to stop ongoing air entry into the venous system. In a sitting-position surgery, venous air embolism can occur when open veins entrain air due to negative intrathoracic pressure. Flooding the surgical field with saline provides a rapid, mechanical barrier that prevents air from entering the veins and helps seal exposed bone surfaces with bone wax if needed. This quick field control buys time to implement other life-support measures, such as giving 100% oxygen and stopping nitrous oxide, and to position the patient to trap any air in the right heart. While turning toward left lateral decubitus with slight head-down and administering high-flow oxygen are critical steps, they follow the immediate field-occlusion action of saline flooding.