Witnessed Intraoperative Air Embolism from Blood Transfusion A Rare Case Under Epidural Anesthesia

Introduction

Intraoperative complications during blood transfusions are rare but potentially life-threatening. A recent case at Afe Babalola University’s Multi System Hospital in Nigeria documented an unusual eventan air embolism triggered during a vesicovaginal fistula repair under epidural anesthesia. This report sheds light on how even routine procedures like transfusions can take a critical turn.
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Case Overview A Rare Air Embolism Witnessed

• Patient: 46-year-old female, post-hysterectomy complication
• Procedure: Vesicovaginal fistula repair under epidural anesthesia
• Complication: Air embolism during intraoperative transfusion
• Trigger: Use of a pressure infuser with suspected air in the blood bag
• Outcome: Stable vitals post-event, managed with prompt intraoperative intervention

The patient, with a history of asthma and suspected deep vein thrombosis, underwent an 8.5-hour surgery with significant blood loss (~2.5 liters). During the third unit of blood transfusion, she audibly noted a hissing soundsuggestive of air entering her bloodstream.

Clinical Response and Management

• Immediate discontinuation of the transfusion set
• Manual attempt to remove air from the venous line
• Increased oxygen delivery (from 2L to 4L/min)
• Hemodynamic parameters remained stable
• Epidural catheter removed on the third postoperative day with uneventful analgesia

A detailed analysis can be found in the main journal article journal.ijcar.1001018

Understanding the Risk Factors Behind Air Embolis

Transfusion-related air embolism is exceptionally rare. However, several contributing factors were identified:

• Air in blood bag or line during pressurized infusion
• Incomplete filling of the transfusion filter chamber
• Venting of blood containers to the atmosphere
• Elevated infusion sites above heart level
• Use of non-collapsible IV containers and warmers releasing dissolved gases

According to the American Society of Anesthesiologists (ASA), continuous presence and vigilance of trained anesthesiologists are key to preventing such intraoperative emergencies.

Preventive Strategies and Recommendations

• Use air-detecting infusion systems where feasible
• Ensure proper priming of transfusion sets
• Avoid pressure infusers without air-check mechanisms
• Monitor filter chambers and tubing for air pockets
• Avoid venting non-collapsible fluid containers
• Clip central lines during syringe/line changes

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