Korean J Anesthesiol.  2014 Dec;67(6):425-428. 10.4097/kjae.2014.67.6.425.

Paradoxical carbon dioxide embolism during laparoscopic cholecystectomy as a cause of cardiac arrest and neurologic sequelae: a case report

• Shin HY
• Kim DW
• Kim JD
• Yu SB
• Kim DS
• Kim KH
• Ryu SJ

• KMID: 2425279
• DOI: http://doi.org/10.4097/kjae.2014.67.6.425

Abstract

An 81-year-old male patient was scheduled for a laparoscopic cholecystectomy due to acute cholecystitis. About 50 minutes into the operation, the arterial blood pressure suddenly decreased and ventricular fibrillation appeared on the electrocardiography. The patient received cardiopulmonary resuscitation and recovered a normal vital sign. We suspected a carbon dioxide embolism as the middle hepatic vein had been injured during the surgery. We performed a transesophageal echocardiography and were able to confirm the presence of multiple gas bubbles in all of the cardiac chambers. After the operation, the patient presented a stable hemodynamic state, but showed weaknesses in the left arm and leg. There were no acute lesions except for a chronic cerebral cortical atrophy and chronic microvascular encephalopathy on the postoperative brain-computed tomography, 3D angiography and magnetic resonance image. Fortunately, three days after the operation, the patient's hemiparesis had entirely subsided and he was discharged without any neurologic sequelae.

Keyword

Carbon dioxide embolism; Cardiopulmonary resuscitation; Paradoxical embolism; Transesophageal echocardiography

MeSH Terms

Aged, 80 and over
Angiography
Arm
Arterial Pressure
Atrophy
Carbon Dioxide*
Cardiopulmonary Resuscitation
Cholecystectomy, Laparoscopic*
Cholecystitis, Acute
Echocardiography, Transesophageal
Electrocardiography
Embolism*
Embolism, Paradoxical
Heart Arrest*
Hemodynamics
Hepatic Veins
Humans
Leg
Male
Paresis
Ventricular Fibrillation
Vital Signs
Carbon Dioxide