VAE Posterior Fossa — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaVAE Posterior FossaFRCA Final

Sitting position posterior fossa surgery: precordial Doppler 'mill-wheel' murmur, ETCO2 drops 4.5→2.1 kPa. Diagnosis and management?

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Correct answer: E — VAE — flood field, lower head, left lateral, aspirate CVC

Mill-wheel murmur + ETCO2 drop in sitting position = VAE. Air enters open venous sinuses above heart level → RV air-lock. Stop insufflation/flood with saline, lower head, compress jugular veins, aspirate CVC, Durant manoeuvre (left lateral), stop N2O, CPR.

Reference: AAGBI/SBNS – 2023 – Posterior fossa procedures