{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:10:15Z","timestamp":1792624215306,"version":"4.5.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Venous air embolism (VAE) is a potentially fatal complication of craniotomy. When a TEE is not used, attention to waveform-level changes during conventional monitoring is crucial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A woman in her 70\u00a0s underwent supratentorial tumor resection in the supine position with a slight head-up tilt. Approximately 1\u00a0h after the craniotomy, gradual decreases in SpO\n                      <jats:sub>2<\/jats:sub>\n                      (98%\u2009\u2192\u200996%), systolic blood pressure (105\u2009\u2192\u200990\u00a0mmHg), and EtCO\n                      <jats:sub>2<\/jats:sub>\n                      (37\u2009\u2192\u200930\u00a0mmHg) were observed. New micro-oscillations appeared on the capnogram plateau, followed by an EtCO\n                      <jats:sub>2<\/jats:sub>\n                      decrease to 22\u00a0mm Hg. VAE was suspected. Treatment, including field flooding, head-down positioning, as well as FiO\n                      <jats:sub>2<\/jats:sub>\n                      , dobutamine, and rapid fluid supplementation, stabilized her and allowed the uneventful completion of surgery. Arterial blood gas levels improved concurrently with EtCO\n                      <jats:sub>2<\/jats:sub>\n                      recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Careful scrutiny of capnogram morphology, not only numeric EtCO\n                      <jats:sub>2<\/jats:sub>\n                      , can expedite the suspicion and timely management of VAE when advanced monitoring is unavailable.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40981-025-00841-5","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T06:23:30Z","timestamp":1765434210000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Capnogram plateau micro\u2011oscillations preceding end\u2011tidal CO2 decline as an early cue to venous air embolism during supratentorial craniotomy: a case report"],"prefix":"10.1186","volume":"12","author":[{"given":"Ayumu","family":"Matsumoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Takeno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7673-8226","authenticated-orcid":false,"given":"Michiyoshi","family":"Sanuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"841_CR1","doi-asserted-by":"publisher","first-page":"798","DOI":"10.21037\/atm-20-497","volume":"8","author":"J Ji","year":"2020","unstructured":"Ji J, Tian Y, Chen L, Li B. Intraoperative venous air embolism in the non-cardiac surgery\u2014the role of perioperative echocardiography in a case series report. Ann Transl Med. 2020;8:798. https:\/\/doi.org\/10.21037\/atm-20-497.","journal-title":"Ann Transl Med"},{"key":"841_CR2","doi-asserted-by":"publisher","first-page":"365","DOI":"10.2217\/fca-2017-0015","volume":"13","author":"N Malik","year":"2017","unstructured":"Malik N, Claus PL, Illman JE, Kligerman SJ, Moynagh MR, Levin DL, et al. Air embolism: diagnosis and management. Future Cardiol. 2017;13:365\u201378. https:\/\/doi.org\/10.2217\/fca-2017-0015.","journal-title":"Future Cardiol"},{"key":"841_CR3","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.3171\/2017.1.JNS162489","volume":"128","author":"H T\u00fcre","year":"2018","unstructured":"T\u00fcre H, Harput MV, Bekiro\u011flu N, Keskin \u00d6, K\u00f6ner \u00d6, T\u00fcre U. Effect of the degree of head elevation on the incidence and severity of venous air embolism in cranial neurosurgical procedures with patients in the semisitting position. J Neurosurg. 2018;128:1560\u20139. https:\/\/doi.org\/10.3171\/2017.1.JNS162489.","journal-title":"J Neurosurg"},{"key":"841_CR4","doi-asserted-by":"publisher","first-page":"e231316","DOI":"10.1136\/bcr-2019-231316","volume":"12","author":"YL Lee","year":"2019","unstructured":"Lee YL, Hwang KY, Yew WS, Ng SY. An abnormal capnography trace due to air embolism in the lateral position. BMJ Case Rep. 2019;12:e231316. https:\/\/doi.org\/10.1136\/bcr-2019-231316.","journal-title":"BMJ Case Rep"},{"key":"841_CR5","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jclinane.2018.08.007","volume":"51","author":"CJ Kapurch","year":"2018","unstructured":"Kapurch CJ, Abcejo AS, Pasternak JJ. The relationship between end-expired carbon dioxide tension and severity of venous air embolism during sitting neurosurgical procedures\u2014a contemporary analysis. J Clin Anesth. 2018;51:49\u201354. https:\/\/doi.org\/10.1016\/j.jclinane.2018.08.007.","journal-title":"J Clin Anesth"},{"key":"841_CR6","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1007\/s00701-016-3034-7","volume":"159","author":"F G\u00fcnther","year":"2017","unstructured":"G\u00fcnther F, Frank P, Nakamura M, Hermann EJ, Palmaers T. Venous air embolism in the sitting position in cranial neurosurgery: incidence and severity according to the used monitoring. Acta Neurochir (Wien). 2017;159:339\u201346. https:\/\/doi.org\/10.1007\/s00701-016-3034-7.","journal-title":"Acta Neurochir (Wien)"},{"issue":"3","key":"841_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/neuopn\/okaa009","volume":"1","author":"R Rahmani","year":"2020","unstructured":"Rahmani R, Susa ST, Sandwell SE, Kimmell KT, Maurer PK, Silberstein HJ, et al. Perioperative risk of the sitting position for elective posterior cervical surgery: a retrospective case series. Neurosurg Open. 2020;1(3):1\u201311. https:\/\/doi.org\/10.1093\/neuopn\/okaa009.","journal-title":"Neurosurg Open"},{"key":"841_CR8","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1007\/s40140-024-00644-x","volume":"14","author":"IG Iavarone","year":"2024","unstructured":"Iavarone IG, Rocco PR, Silva PL, Taran S, Wahlster S, Schultz MJ, et al. Perioperative ventilation in neurosurgical patients: considerations and challenges. Curr Anesthesiol Rep. 2024;14:512\u201324. https:\/\/doi.org\/10.1007\/s40140-024-00644-x.","journal-title":"Curr Anesthesiol Rep"},{"key":"841_CR9","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/ANA.0000000000000534","volume":"31","author":"AS Abcejo","year":"2019","unstructured":"Abcejo AS, Pasternak JJ, Perkins WJ. Urgent repositioning after venous air embolism during intracranial surgery in the seated position: a case series. J Neurosurg Anesthesiol. 2019;31:413\u201321. https:\/\/doi.org\/10.1097\/ANA.0000000000000534.","journal-title":"J Neurosurg Anesthesiol"},{"key":"841_CR10","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1007\/s10877-020-00568-x","volume":"35","author":"TR Rau","year":"2021","unstructured":"Rau TR, Plaschke K, Weigand MA, Maier C, Schramm C. Automatic detection of venous air embolism using transesophageal echocardiography in patients undergoing neurological surgery in the semi-sitting position: a pilot study. 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