Korean J Anesthesiol.  2012 Nov;63(5):469-472. 10.4097/kjae.2012.63.5.469.

Cardiac arrest associated with carbon dioxide gas embolism during laparoscopic surgery for colorectal cancer and liver metastasis: A case report

• Kim IS
• Jung JW
• Shin KM

• KMID: 1767219
• DOI: http://doi.org/10.4097/kjae.2012.63.5.469

Abstract

Clinically apparent carbon dioxide (CO2) gas embolism is uncommon, but it may be a potentially lethal complication if it occurs. We describe a 40-year-old woman who suffered a CO2 gas embolism with cardiac arrest during laparoscopic surgery for colorectal cancer and liver metastasis. Intra-abdominal pressure was controlled to less than 15 mmHg during CO2 gas pneumoperitoneum. The right hepatic vein was accidentally disrupted during liver dissection, and an emergent laparotomy was performed. A few minutes later, the end-tidal CO2 decreased, followed by bradycardia and pulseless electrical activity. External cardiac massage, epinephrine, and atropine were given promptly. Ventilation with 100% oxygen was started and the patient was moved to the Trendelenburg position. Two minutes after resuscitation was begun, a cardiac rhythm reappeared and a pulsatile arterial waveform was displayed. A transesophageal echocardiogram showed air bubbles in the right pulmonary artery. The patient recovered completely, with no cardiopulmonary or neurological sequelae.

Keyword

Carbon dioxide gas embolism; Laparoscopic surgery; Transesophageal echocardiography

MeSH Terms

Adult
Atropine
Bradycardia
Carbon
Carbon Dioxide
Colorectal Neoplasms
Echocardiography, Transesophageal
Embolism, Air
Epinephrine
Female
Head-Down Tilt
Heart Arrest
Heart Massage
Hepatic Veins
Humans
Laparoscopy
Laparotomy
Liver
Neoplasm Metastasis
Oxygen
Pneumoperitoneum
Pulmonary Artery
Resuscitation
Ventilation
Atropine
Carbon
Carbon Dioxide
Epinephrine
Oxygen