Cardiac Arrest due to Carbon Dioxide Embolism During Laparoscopic Gynecologic Surgery of a Patient with Previous Abdominal Surgery: A Case Report

Catastrophic carbon dioxide (CO2) embolism is a rare, but potentially life-threatening, the complication of laparoscopic gynecologic surgery. We report the case of a healthy 53-year-old woman who developed CO2 embolism and cardiac arrest during laparoscopic surgery. She had a history of two cesarean sections and had extensive peritoneal adhesions. After placement of the trocar and insufflation of CO2, end-tidal CO2 dropped from 35 to 15 mm Hg, and the patient had a cardiovascular collapse. In this patient, CO2 embolism was diagnosed on the basis of a sudden decrease in end-tidal CO2, hypotension, and hypoxemia. The patient was managed quickly and aggressively. The patient recovered completely following the treatment for CO2 embolism, with no cardiopulmonary or neurological sequelae. There is an increased risk of catastrophic CO2 embolism during laparoscopic gynecologic surgery in patients with previous abdominal surgery. Therefore, the surgeon and anesthesiologist should remain vigilant to promote early detection of CO2 embolism.

Carbon dioxide embolism with severe hypotension as an initial symptom during laparoscopy: a case report

Laparoscopy is widely used because it induces minimal postoperative pain and facilitates rapid recovery. However, carbon dioxide (CO2) embolism is a rare but potentially fatal complication of laparoscopic surgery. Earlier reports have shown that decreased end-tidal CO2 (ETCO2) and increased partial pressure of CO2 might be useful indicators of CO2 embolism. We herein report a case of CO2 embolism after the freed bladder neck was released during laparoscopic radical prostatectomy. Sudden hemodynamic disorder and increased ETCO2 combined with immediate arterial blood gas analysis led us to suspect CO2 embolism, which was confirmed by the aspiration of foamy blood from the central venous catheter. The patient was successfully resuscitated and recovered well. This case illustrates that hemodynamic collapse accompanied by increased ETCO2 can indicate CO2 embolism.

Paradoxical carbon dioxide embolism during laparoscopic surgery without intracardiac right-to-left shunt: two case reports and a brief review of the literature

We herein report two cases of paradoxical carbon dioxide (CO2) embolism during laparoscopic nephrectomy and hepatic left lateral lobectomy without evidence of a right-to-left shunt or obvious rupture of blood vessels. Transesophageal echocardiography detected paradoxical CO2 embolism before the end-tidal CO2 partial pressure (PETCO2) dropped from baseline. The pneumoperitoneum was reduced or stopped immediately after detection of the embolism. One patient developed a postoperative epileptiform seizure. In the other patient, many gas bubbles were drawn out from the central venous line. We speculate that rapid introduction of pneumoperitoneum pushed a large amount of CO2 into the abdominal blood vessels, exceeding the gas exchange capacity of the lung and causing CO2 bubble formation in the left-side cardiac system. These two cases indicate that intraoperative transesophageal echocardiography can reduce the influence of CO2 embolism during laparoscopic tumor surgery by early diagnosis of the embolism and provide helpful information to establish a list of differential diagnoses of postoperative complications.