A 39-year-old female requiring repeat cesarean section presented with a history of chronic hypertension and primary hyperparathyroidism requiring no treatment. Following prehydration, a T4level epidural anesthetic was produced with 0.5% bupivacaine. The patient was placed supine on a level OR table with left uterine displacement and routine monitoring, including a precordial ultrasonic Doppler, was performed. Immediately after surgical incision, during subcutaneous dissection, the Doppler signal changed to one consistent with venous air embolism, and the patient complained of chest pain, shortness of breath and nausea, while monitors demonstrated tachypnea, a decrease in SaO2to 74%, and transient runs of VT. Administration of O2, IV lidocaine, and IV ephedrine, placement in the Trendelenburg position, and flooding the field with saline, gradually resolved the symptoms and led to delivery of a stable and normal infant. No air was aspirated from a central venous line. Post-operatively, there were some transient signs of pulmonary congestion and wheezing.