Air embolism related to removal of Mayfield head pins
A 33 year old male after 2 weeks of the first surgery (burr hole) for subdural hematoma, he was presented again to ED with headache for 4 days, GCS 15, general condition good, hemodynamically stable, no neurological deficit. He was admitted to High Dependency Unit for close observation.\nAll laboratory investigations were normal including CT scan, MRI, MRA, and cerebral angiography.\nUnder general anesthesia and invasively monitored, using Mayfield head pins, left pterional craniotomy approach and left temporal lobe subdural hematoma was evacuated. The patient was hemodynamically stable during surgery.\nAt the conclusion of surgery and immediately after removal of head pins, the blood pressure suddenly dropped from 144/94 mmHg to 60/30 mmHg and heart rate from 70 to 50 and associated with drop of the ETCO2 from 32 to 27 mmHg, managed with O2 100%, Ephedrine 30 mg and IV fluid, his vital signs returned to normal values within 1-2 min. By the end of surgery, the endotracheal tube was removed and he was fully awake. Follow up CT scan showed clear brain and clinically with no neurological deficit.