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Background: Venous air embolism (VAE) and paradoxical air embolism (PAE) are serious complications associated with the sitting position for neurosurgery. Although PAE is the result of VAE, the incidence of PAE according to the severity of VAE has not been investigated systematically in humans.

Methods: Twenty‐one patients scheduled for neurosurgery in the sitting position were investigated prospectively. VAE and PAE were continuously monitored by cardiac two‐dimensional 4‐chamber view using transesophageal echocardiography (TEE) and the severity of VAE and PAE was quantitatively graded from 0 to 3 by the microbubbles score. Haemodynamic parameters and end‐tidal CO₂ concentration (P_ETCO₂) during VAE and PAE were also recorded.

Results: Microbubbles in the right atrium appeared in all patients and the number of patients involved in grades 0, 1, 2 and 3 of VAE was 0, 10, 3 and 8 …