Carbon Dioxide Embolism during Laparoscopic Surgery

Abstract

Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.

Massive Carbon Dioxide Embolism During Pneumoperitoneum for Laparoscopic Adrenalectomy: A Case Report

“…Most serious cases of CO 2 embolism reported in the literature occurs during the beginning of the procedure, usually due to the misplacement of the Veress needle either directly into a vein or parenchymal organ4. Lesser amounts of CO 2 may also enter circulation through openings in injured vessels, as seen in our case, which explains the late onset of the carbon dioxide embolisms [4]. Rapid entrainment of a large volume of gas can lead to the formation of large emboli, which may lodge in a large central vessel and potentially lead to cardiovascular collapse [5].…”

“…This is especially true when the CO 2 from the right heart flows into the left heart [3] Clinically, carbon dioxide embolism can present itself with systemic hypotension, dyspnea, cyanosis, tachycardia or bradycardia, arrhythmia or asystole, elevated pulmonary arterial pressure(PAP), elevated central venous pressure, hypoxemia and increased arterial partial pressure of carbon dioxide, increase or decrease end-tidal carbon dioxide tension [4]. There are case reports about cardiac arrest associated with CO2 embolism during laparoscopic surgery8.…”

Threshing grain of mechanism from chaffy myth of air embolism in laparoscopy - lux et veritas

“…These cells are transported by gas flow in PP to remote ports due to gas leaks by chimney effect; harbinger of metastases at other than retrieval ports. 7 Leakage of gases occur in and out of sides of cannulae from various ports mixing AA even when CO2 is used, against surgical will, compounding SS, which determines final chemistry of venous GE. Thus, precise composition of SS, hence ensuing embolus, in various stages of OL is difficult to reckon at the fateful moment of venous embolus origin.…”

“…7,12 Kelling used air in dog to create IAP of 100mmHg in Lufttamponde published in 1901 as Kolioskopie. [13][14][15][16][17] Jacobaeus performed abdominal endoscopy in 1910 and carried out 115 cases with one serious complication of bleeding without AE.…”

“…CO2 is used empirically even when complications attributed to air are occurring with it. 7,15 It prompted technical review of biomechanics of CO2 vis-avis AE or GE versus AL or GL in RH and PT, and other evolving pulmonary immunopathological factors.…”