Jordan Gribbins,a 69-year-old pipe smoker with a history of cardiac disease and atrial rhythm disturbance,is scheduled for a supratentorial craniotomy and is securely positioned in a semisitting position.The perioperative nurse and anesthesia provider have discussed the anesthesia plan and Mr.Gribbin's surgical and anesthesia risks,and agree that he is at risk for venous air embolism (VAE).Sequential compression devices have been placed on both legs.Pulmonary lines have been placed and the nurse has prepared an area for preparation of TEE (transesophageal electrocardiography),if needed.During the procedure,Mr.Gribbins reacted with decreases in arterial pressure and end-tidal CO₂.Precordial "washing machine" sounds emanated from the Doppler.What should the perioperative nurse anticipate as a possible next response?

Question

Quizplus · Accepted Answer

A repositioning to the left lateral decubitus position (right side up)may be indicated to prevent the air in the atrium from moving to the ventricle and causing an air lock.If the patient's position cannot be changed because of the positioning apparatus,the tilt of the OR bed can be adjusted to lower the source of air entry and decrease the negative air pressure gradient.The perioperative nurse partners with the anesthesia provider,neurosurgeon,and scrub person to provide safety for patients during seated neurosurgical procedures.
Once VAE has been diagnosed,a critical component of treatment is to prevent further air entrainment.The nurse should ensure saline-soaked sponges are available on the sterile field so the surgeon can immediately cover the surgical site.The surgeon should then assess and eliminate any entry site to prevent additional air entry.The anesthesia provider is responsible for attempting to aspirate the air by way of the multiorifice right atrial catheter and may administer ephedrine,dobutamine,or norepinephrine to provide inotropic support to the right ventricle.

Jordan Gribbins,a 69-Year-Old Pipe Smoker with a History of Cardiac