Re-insufflation after deflation of a pneumoperitoneum is a risk factor for CO2 embolism during laparoscopic prostatectomy: A case report.
10.4097/kjae.2010.59.S.S201
- Author:
Chae Lim SEONG
1
;
Eun Ji CHOI
;
Sun Ok SONG
Author Information
1. Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea. sosong@med.yu.ac.kr
- Publication Type:Case Report
- Keywords:
Cardiovascular collapse;
CO2 embolism;
Laparoscopic prostatectomy;
Re-insufflation
- MeSH:
Aged;
Anoxia;
Carbon Dioxide;
Cardiotonic Agents;
Embolism;
Hemodynamics;
Humans;
Hypotension;
Insufflation;
Laparoscopy;
Laparotomy;
Pneumoperitoneum;
Prostate;
Prostatectomy;
Risk Factors
- From:Korean Journal of Anesthesiology
2010;59(Suppl):S201-S206
- CountryRepublic of Korea
- Language:English
-
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.
