Episode 12: Air Embolism with Dr. David Mintz

Air embolism represents a critical, life-threatening complication in anesthesia, particularly during procedures where venous structures remain open above the level of the heart, such as craniotomies or central line placements. Neuroanesthesiologist Dr. David Mintz highlights that clinical suspicion relies on monitoring for sudden cardiovascular collapse or unexplained hypotension and tachycardia. While transesophageal echocardiography serves as the gold standard for detection, the precordial Doppler and end-tidal nitrogen monitoring provide practical alternatives. Immediate management requires alerting the surgical team to seal the entry site, discontinuing nitrous oxide, and administering epinephrine to support right heart function. Furthermore, while positive end-expiratory pressure (PEEP) can help prevent air entrainment, it must be carefully managed or discontinued if a patent foramen ovale is suspected to prevent devastating right-to-left shunting and potential stroke.