Korean J Anesthesiol.  2010 Dec;59(Suppl):S201-S206. 10.4097/kjae.2010.59.S.S201.

Re-insufflation after deflation of a pneumoperitoneum is a risk factor for CO2 embolism during laparoscopic prostatectomy: A case report

• Seong CL
• Choi EJ
• Song SO

• KMID: 2237388
• DOI: http://doi.org/10.4097/kjae.2010.59.S.S201

Abstract

Although symptomatic carbon dioxide (CO2) embolism is rare, it recognized as a potentially fatal complication of laparoscopic surgery. Sudden hemodynamic instability could be a CO2 embolism especially during insufflation. A 65-year-old man received laparoscopic prostatectomy for 5 hours under CO2 pneumoperitoneum without any problem. After resection of prostate, it was stopped following deflation. Thirty minutes later, peumoperitoneum was re-induced to continue the operation. Shortly after re-insufflation, the patient revealed hemodynamic instability suggested a CO2 embolism; severe hypotension, tachyarrythmia, hypoxemia, increased CVP, and changed end-tidal CO2. Gas insufflation was stopped. He was managed with Durant's position, fluid and cardiotonics for 20 minutes. The residual was completed by open laparotomy. Re-insufflation, inducing gas entry through the injured vessels, might be a risk factor for CO2 embolism in this case. The risk to the patient may be minimized by the surgical team's awareness of CO2 embolism and continuous intra-operative monitoring of end-tidal CO2.

Keyword

Cardiovascular collapse; CO2 embolism; Laparoscopic prostatectomy; Re-insufflation

MeSH Terms

Aged
Anoxia
Carbon Dioxide
Cardiotonic Agents
Embolism
Hemodynamics
Humans
Hypotension
Insufflation
Laparoscopy
Laparotomy
Pneumoperitoneum
Prostate
Prostatectomy
Risk Factors
Carbon Dioxide
Cardiotonic Agents