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Fuentes S, Grande-Moreillo C, Margarit-Mallol J, Flores-Villar S, Solé-Heuberger E, Jaen-Manzanera A. Gas Embolism in Pediatric Minimally Invasive Surgery: Should It Be a Concern? J Laparoendosc Adv Surg Tech A 2023; 33:1011-1017. [PMID: 37253132 DOI: 10.1089/lap.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Introduction: Gas embolism can occur during minimally invasive surgical procedures. Its incidence and implications in infants and children are not clear. The objective of this study is to identify gas embolism with transthoracic echocardiography and its consequences in pediatric laparoscopic appendectomy. Materials and Methods: This is a descriptive observational study including children undergoing laparoscopic appendectomy. We performed transthoracic echocardiography during surgery and collected data on intraoperative hemodynamic and respiratory parameters. Results: To date, we have included 10 patients in whom intraoperative transthoracic echocardiography revealed a 50% incidence of gas embolism. All episodes of embolism were grade I or II, and the patients remained asymptomatic. The hemodynamic and respiratory parameters varied slightly during the pneumoperitoneum. Conclusions: Episodes of gas embolism in pediatric laparoscopic appendectomy appeared in up to 50% of patients. Although they were subclinical, we should be aware of the risk of serious events and take measures to maximize safety in pediatric minimally invasive surgery.
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Affiliation(s)
- Sara Fuentes
- Pediatric Surgery Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Carme Grande-Moreillo
- Pediatric Surgery Department, Hospital Universitari Mútua de Terrassa, Consorci Sanitari Alt Penedès i Garraf, Spain
| | - Jaume Margarit-Mallol
- Pediatric Surgery Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | | | | | - Angels Jaen-Manzanera
- Coordinadora Avaluació i Suport a la Recerca, Fundació Docència i Recerca Mútua Terrassa, Terrassa, Spain
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Patterson KN, Beyene TJ, Minneci PC, Diefenbach KA. Rates of Air Embolism in Pediatric Patients Undergoing Surgical Procedures of the Peritoneum. J Laparoendosc Adv Surg Tech A 2022; 32:1220-1227. [PMID: 36318787 DOI: 10.1089/lap.2022.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Air embolism during laparoscopic surgery is a rare but feared complication in the pediatric population. The objective of this study was to identify rates of air embolus in pediatric patients during hospitalization for laparoscopic or open surgical procedures of the peritoneal cavity. Materials and Methods: Patients 0-18 years old within the Pediatric Health Information System who underwent a predefined, common inpatient laparoscopic or open surgical procedure involving the peritoneal cavity from 2015 to 2020 were studied. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for air embolism were then searched among patients during the same admission. Firth logistic regression was used to compare rates of air embolism in open and laparoscopic cohorts and in patients >1 and ≤1 year. Results: Unadjusted rates of air embolism were higher in patients undergoing open compared with laparoscopic surgery (open: 9/45,080; 20.0/100,000 patients versus laparoscopic: 3/101,892; 2.9/100,000 patients). In patients ≤1 year (45,726), 2 patients undergoing open surgery (2/1,031; 9.5/100,000 patients) and all 3 patients undergoing laparoscopic surgery had an air embolism diagnosis (3/22,329; 13.4/100,000 patients). For laparoscopic surgery, a suggested lower relative risk (RR) of air embolism was demonstrated for children >1 year compared with children ≤1 year (RR: 0.05, P = .05). Conclusion: Air embolism associated with common pediatric surgical procedures of the peritoneum is rare and patients undergoing laparoscopic and open surgery have similar risks for air embolism. Although rare, the risk should be considered during surgical planning and abdominal access, especially in children ≤1 year old.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Lin AC, Olecki EJ, Good ML, Cowart C, Scow JS. Carbon Dioxide Embolism Resulting From Liver Laceration During Peritoneal Optical Trocar Entry. Cureus 2022; 14:e28132. [PMID: 36134094 PMCID: PMC9482383 DOI: 10.7759/cureus.28132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Venous air emboli have been reported to occur in numerous settings, including trauma, various surgical procedures, both laparoscopic and radiologically, and even idiopathically. In this case study, a liver laceration was made during a robot-assisted left colectomy and colostomy in a 69-year-old female resulting in air embolism during insufflation. A drop in end-tidal CO2 was noted and the patient went into immediate cardiac arrest. Adequate pressure was applied and over-suturing of the liver laceration was made with reverse Trendelenburg positioning during the administration of cardiopulmonary resuscitation (CPR) for approximately one minute. The patient completed an open hemicolectomy the following day and made a complete recovery. Preventative and intraoperative measures to prevent further recurrences of venous air emboli are discussed.
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Jeon S, Hong JM, Lee HJ, Kim Y, Kang H, Hwang BY, Lee D, Jung YH. Paradoxical carbon dioxide embolism during laparoscopic hepatectomy without intracardiac shunt: A case report. World J Clin Cases 2022; 10:2908-2915. [PMID: 35434095 PMCID: PMC8968813 DOI: 10.12998/wjcc.v10.i9.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/15/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic hepatectomy has recently become popular because it results in less bleeding than open hepatectomy. However, CO2 embolism occurs more frequently. Most CO2 embolisms during laparoscopic surgery are self-resolving and non-symptomatic; however, severe CO2 embolism may cause hypotension, cyanosis, arrhythmia, and cardiovascular collapse. In particular, paradoxical CO2 embolisms are highly likely to cause neurological deficits. We report a case of paradoxical CO2 embolism found on transesophageal echocardiography (TEE) during laparoscopic hepatectomy, although the patient had no intracardiac shunt.
CASE SUMMARY A 71-year-old man was admitted for laparoscopic left hemihepatectomy. During left hepatic vein ligation, the inferior vena cava was accidentally torn. We observed a sudden drop in oxygen saturation to 85%, decrease in systolic blood pressure (SBP) below 90 mmHg, and reduction in end-tidal CO2 to 24 mmHg. A “mill-wheel” murmur was auscultated over the precordium. The fraction of inspired oxygen was increased to 100% with 5 cmH2O of positive end-expiratory pressure (PEEP) and hyperventilation was maintained. Norepinephrine infusion was increased to maintain SBP above 90 mmHg. A TEE probe was inserted, revealing gas bubbles in the right side of the heart, left atrium, left ventricle, and ascending aorta. The surgeon reduced the pneumoperitoneum pressure from 17 to 14 mmHg and repaired the damaged vessel laparoscopically. Thereafter, the patient’s hemodynamic status stabilized. The patient was transferred to the intensive care unit, recovering well without complications.
CONCLUSION TEE monitoring is important to quickly determine the presence and extent of embolism in patients undergoing laparoscopic hepatectomy.
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Affiliation(s)
- Soeun Jeon
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Jeong-Min Hong
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Hyeon Jeong Lee
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Yesul Kim
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
| | - Hyunjong Kang
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
| | - Boo-young Hwang
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Dowon Lee
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Young-hoon Jung
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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Landman MP, Billmire D. Umbilical access in laparoscopic surgery in infants less than 3 months of age: A survey of the American Pediatric Surgical Association. J Pediatr Surg 2020; 55:2094-2098. [PMID: 32147235 DOI: 10.1016/j.jpedsurg.2020.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/03/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Laparoscopy is commonplace in pediatric surgery. Abdominal access via the umbilicus may present a unique challenge in neonates and young infants predisposing them to complications. We hypothesized that these complications may occur more than described in the literature. METHODS Members of the American Pediatric Surgical Association (APSA) were anonymously surveyed in February of 2018 via REDCap™ regarding technique of umbilical access in infants less than 3 months of age and complications experienced during umbilical access. Approval was obtained from the IRB and the APSA Outcomes and Evidence-based Practice Committee. RESULTS The response rate was 31.3% (329/1050). 62.3% of respondents performed 21 or greater neonatal laparoscopic procedures annually. 34 of 322 respondents reported a direct complication from umbilical access for laparoscopy in this age group (10.6%). Surgeons described 37 specific cases with complications related to umbilical access, with laparoscopic pyloromyotomy making up 47.2% (17/36). CO2 embolism was the most common complication; 15.4% of surgeons reported not knowing about the possibility of CO2 embolism. 41% of surgeons confirm intraabdominal placement of the umbilical trocar prior to insufflation. There was no association between any complication and where the umbilical trocar was placed (above/below/through umbilicus) or placement technique in patients with no umbilical cord stump. There may be an association between complication and where the umbilicus is entered in patients with an umbilical cord stump still in place (p = 0.013). CONCLUSIONS Umbilical access for laparoscopy in neonates and infants less than 3 months of age can present a unique challenge and result in significant complications. All techniques and methods had complications. Surgeons should be aware of these risks and be prepared to manage them emergently if they arise. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Matthew P Landman
- Indiana University, Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN.
| | - Deborah Billmire
- Indiana University, Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN
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de Jong KIF, de Leeuw PW. Venous carbon dioxide embolism during laparoscopic cholecystectomy a literature review. Eur J Intern Med 2019; 60:9-12. [PMID: 30352722 DOI: 10.1016/j.ejim.2018.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/14/2018] [Indexed: 12/21/2022]
Abstract
Laparoscopy has become the procedure of choice for routine gallbladder removal. A serious complication of this technique is the occurrence of gas emboli due to insufflation. It is associated with a high mortality rate of around 28%. The present systematic review intends to provide more insight into causes, symptoms and risk factors for this specific complication and to explore which measures should be taken to treat and prevent it. The Cochrane library and Pubmed were used as sources. Articles and their references were selected when they were related to the subject in sufficient detail. The course of this complication can vary from asymptomatic up to impairment of normal flow through the right ventricle (RV) or pulmonary artery, potentially leading to acute heart failure. The severity depends on the amount of gas, the rate of accumulation and the ability to remove the gas bubbles. It is difficult to estimate the true incidence of venous gas embolism during laparoscopic cholecystectomy as there are various diagnostic tools, each with different sensitivity. Precautions that need to be taken are: correct positioning of the needle, low insufflation pressure, low insufflation speed, screening for hypovolemia, Trendelenburg positioning, availability of intervention equipment at operation table, no placement of venous catheters during inspiration and catheter removing during expiration. Physicians need to be more aware of this harmful complication and the preventative measurements that need to be taken. As there are virtually no prospective data, future studies are needed to gain more knowledge on gas emboli during laparoscopic cholecystectomy.
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Affiliation(s)
- Kiki I F de Jong
- Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Peter W de Leeuw
- Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
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Tognon C, De Corti F, Michelon S, Gamba P. Carbon dioxide embolism during laparoscopic lymph-node biopsy in a girl: A rare occurrence. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Olsen M, Avery N, Khurana S, Laing R. Pneumoperitoneum for neonatal laparoscopy: how safe is it? Paediatr Anaesth 2013; 23:457-9. [PMID: 23577821 DOI: 10.1111/pan.12146] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 10/27/2022]
Abstract
We present the case of a 3 day old term neonate who experienced a cardiopulmonary arrest during creation of pneumoperitoneum for laparoscopic repair of duodenal atresia. The arrest was thought likely to have occurred as a result of a gas embolism. We discuss the features of the neonatal circulation which may predispose neonates to embolic phenomena during laparoscopic procedures, and the potential benefit of priming the insufflation apparatus with carbon dioxide. The possibility of gas embolism should be considered when contemplating laparoscopic surgery in this patient group.
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Affiliation(s)
- Melanie Olsen
- Department of Children's Anesthesia, Women's and Children's Hospital, North Adelaide, SA, Australia.
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9
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Air in the insufflation tube may cause fatal embolizations in laparoscopic surgery: an animal study. Surg Endosc 2012; 27:1791-7. [PMID: 23239303 DOI: 10.1007/s00464-012-2651-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 09/27/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the risk of an air embolization with the volume of the insufflation tube during induction of laparoscopy. A further objective was to determine the LD₅₀ of air in young piglets. METHODS End-tidal carbon dioxide pressure ([Formula: see text]), pulmonary arterial pressure (P pa), heart rate (f c), and mean arterial pressure (P a carot) were measured in 17 piglets divided into three groups: group 1 (n = 6), bolus application (CO₂ embolization, followed by air embolization, 2 mL/kg each), group 2 (n = 7), continuous air embolization (30 min, 0.2 mL/kg/min), and group 3 (n = 4), continuous CO₂ embolization (30 min, 0.4 mL/kg/min). RESULTS All animals survived CO₂ embolism. Air embolization as a bolus (2 mL/kg) or with an accumulated volume of 3.1 mL/kg led to death. Decreases in [Formula: see text] indicated air or massive CO₂ embolization only. There was a good correlation between [Formula: see text] and P pa in case of air embolization (r = -0.80, p < 0.0001). In contrast, no dependency was recognized during CO₂ embolism (r = -0.17, p = 0.2). CONCLUSIONS In order to minimize the lethal risk of gas embolization, the insufflation system has to be completely filled with CO₂ before connecting to the patient.
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Richter S, Hückstädt T, Aksakal D, Klitscher D, Wowra T, Till H, Schier F, Kampmann C. Embolism Risk Analysis—Helium Versus Carbon Dioxide. J Laparoendosc Adv Surg Tech A 2012; 22:824-9. [DOI: 10.1089/lap.2012.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steffen Richter
- Department of Pediatric Surgery, University Medical Center, Leipzig, Germany
| | - Thomas Hückstädt
- Department of Pediatrics, University Medical Center, Mainz, Germany
| | - Devrim Aksakal
- Department of Pediatric Surgery, University Medical Center, Mainz, Germany
| | - Daniela Klitscher
- Department of Traumatology, University Medical Center, Mainz, Germany
| | - Tobias Wowra
- Department of Pediatric Surgery, University Medical Center, Leipzig, Germany
| | - Holger Till
- Department of Pediatric Surgery, University Medical Center, Leipzig, Germany
| | - Felix Schier
- Department of Pediatric Surgery, University Medical Center, Mainz, Germany
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Successful Resuscitation After Carbon Dioxide Embolism During Laparoscopy. Surg Laparosc Endosc Percutan Tech 2012; 22:e164-7. [DOI: 10.1097/sle.0b013e31825150a9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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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.
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Affiliation(s)
- Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Zikry AA, Desousa K, Alanezi KH. Carbon dioxide embolism during laparoscopic sleeve gastrectomy. J Anaesthesiol Clin Pharmacol 2011; 27:262-5. [PMID: 21772696 PMCID: PMC3127315 DOI: 10.4103/0970-9185.81840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG) in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO(2) at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO(2) and SaO(2) % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.
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Affiliation(s)
- Amir Abu Zikry
- Department of Anaesthesia and ICU, Al Salam International Hospital, Kuwait
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14
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Taylor SP, Hoffman GM. Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant. Can J Anaesth 2010; 57:774-8. [PMID: 20431981 DOI: 10.1007/s12630-010-9320-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufflation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufflation of laparoscopic gas resulted in immediate cardiovascular collapse requiring prolonged resuscitation. Persistent intracranial emboli following the arrest may have resulted from nitrogen contamination of the delivered gas. CLINICAL FEATURES A 12-day-old female underwent laparoscopy for pyloric stenosis. During initial insufflation of the abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide (CO(2ET)) associated with bradycardia and pulseless electrical activity. Three hours after successful resuscitation and open pyloromyotomy, computerized tomography documented intra-arterial gas within the cerebral and hepatic circulations that resolved following hyperbaric oxygen therapy. Magnetic resonance imaging five days later revealed watershed infarcts in the right frontal and parietal regions. Nitrogen, an insoluble gas not easily eliminated from the body, was likely the gas present within the patient's circulation several hours after the event. It was unlikely carbon dioxide, which is a highly soluble gas that binds to hemoglobin and is rapidly buffered by the carbonic anhydrase system and excreted by the lung. Room air contamination of high volume insufflation tubing allows nitrogen to enter body cavities during endoscopic procedures. CONCLUSION Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures.
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Affiliation(s)
- Susan P Taylor
- Department of Pediatric Anesthesiology, Children's Hospital of Wisconsin, Milwaukee, USA.
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Kudsi OY, Jones SA, Brenn BR. Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report. J Pediatr Surg 2009; 44:842-5. [PMID: 19361651 DOI: 10.1016/j.jpedsurg.2008.11.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 11/14/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
Abstract
Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein. The diagnosis of carbon dioxide embolism was made on the basis of the abrupt decrease in end-tidal CO(2), sudden decreased Spo(2), hypotension, and cyanosis. Portable x-ray with the clinical presentation was sufficient for a diagnosis of carbon dioxide embolism. Treatment included termination of CO(2) insufflation, placing the patient in Durant's position, and adequate resuscitation as necessary. Despite the fact that the insufflation pressure was in the recommended range, a carbon dioxide embolism was thought to be caused by injection of carbon dioxide into a patent umbilical vein. Although laparoscopic pyloromyotomy has demonstrated to be a safe and effective procedure, this is a serious and rare complication causing prolonged length of stay and skewed hospital charges.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Lankenau Hospital and Institute for Medical Research, Wynnewood, PA 19096, USA
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