ABSTRACT
Venous air embolism (VAE) can be a lethal complication of surgical procedures during which (1) venous pressure at the site of surgery is subatmospheric or (2) air (or gas) is forced under pressure into a body cavity. We experienced a case of fatal massive venous air embolism during lung surgery in a 52 years old patient undergoing a right upper lobectomy and right lower lobe superior segment wedge resection for lung cancer. Anesthetic induction and the initial intraoperative course were completely uneventful until sudden severe hypotension and abrupt bradycardia occurred after artificial air insufflation into the intraabdominal cavity through the diaphragm to reduce the dead space of the thoracic cavity. We considered a venous air embolism as the etiology of these events and treated the patient with manual cardiac massage, various cardiotonic drugs and removal of air through the right atrium. The patient was extubated at 3 days after surgery and discharged from the hospital without the complication of the venous air embolism.