Case of the Month #59 A case of unexplained postoperative unresponsiveness

Published 18/12/2025

Take home message:

  • Vascular gas embolism is the entrainment of air (or exogenously delivered gas) from the environment into the venous or arterial vasculature, producing systemic effects.  

 

  • A periprocedural stroke or neurological event should always be regarded as gas embolism with cerebral involvement until proven otherwise  

 

  • Gas embolism is a medical emergency and should be managed accordingly 

 

  • Consider early discussion with the local/nearest Hyperbaric Unit. Ideally treatment to be started within 6-7 hours but delayed hyperbaric therapy can still be lifesaving and should be considered if logistics and patient’s hemodynamic allow. 

 

  • The diagnosis is often difficult, when a small amount of gas is involved; or if the patient is anaesthetised or sedated. Constant vigilance plus awareness of the condition and risk factors is the most important diagnostic tool.