Early Detection is Vital in Successful Resuscitation after Massive Mixed-air and Carbon dioxide Venous Embolism during Laparoscopic Surgery

Air embolism is a life threatening condition, which is commonly reported in sitting position surgery or when the venous sinuses are open. Symptoms may appear depending on volume of air entrained and rate of entrainment. Lung acts as a filter and if the area exposed is more than the critical volume, then ventilation – perfusion (V/Q) mismatch leads to hypoxia and ultimately death. In contrast, carbon dioxide in large volume, lead to right ventricular outflow tract (RVOT) obstruction and reduce cardiac output. In people with probe patent patent foramen ovale, this can reach left atrium and lead to systemic embolism. Laparoscopic surgery, in general is safe and in situations, where there is abnormal organ placement and arterio venous connection may lead to gas placement into circulation. Detection is by trans esophageal echocardiography, precordial doppler, end tidal carbon dioxide monitoring and pulse oximetry. We present one such case with altered anatomy leading to ptosis of liver and massive mixed air and carbon dioxide embolism, which was successfully re-suscitated. Keywords: Air embolism; Carbon dioxide embolism; Laparoscopy.