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Jerry D. Levitt, MD; Magnus Hägerdal, MD; Roger J. Bagshaw, MD; M. Mehdi Keykhah, MD
University of Pennsylvania School of Medicine Philadelphia

JAMA. 1978;240(2):110.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Our group of neurosurgical anesthesiologists disagrees with the belief of Albin et al (239:496, 1978) that patients undergoing lumbar disk surgery in the knee-chest position should have a right atrial catheter placed preoperatively.

Although the venous pressure at the lumbar incision is probably low and air embolism is a theoretic possibility, there is a conspicuous absence of reports of hemodynamically significant air embolism in patients undergoing this common operation. Albin et al refer to the case of Shenkin and Goldfedder (210:726, 1969) as an example of fatal air embolism occurring in a prone patient. However, that patient's operation was not a laminectomy but posterior-fossa exploration for an arteriovenous malformation. Furthermore, the air embolism occurred after hemorrhage and after the venous pressure was further lowered by ganglionic blockade in addition to head-up tilt and mechanical ventilation with a negative-pressure phase.

We place a right atrial catheter and use . . . [Full Text PDF of this Article]

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