Journal of Anaesthesia & Critical Care Case Reports

Vol 6 | Issue 2 | May-Aug 2020 | page: 14-16 | Surendranath V, Radhakrishna Patta, Raghavendran K

Author: Surendranath V [1], Radhakrishna Patta [2], Raghavendran K [2]

[1] Department of Anaesthesiology, SRM Institutes for Medical Sciences, Chennai, INDIA.
[2] Department of Surgical Gastroenterology, SRM Institutes for Medical Sciences, Chennai, INDIA.

Address of Correspondence
Dr. Surendranath V,
Consultant, Department of Anaesthesiology, SRM Institutes for Medical Sciences, Chennai, INDIA
E-mail: drsuren20@gmail.com

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.

References

1. Wittenberg AG, Richard AJ, Conrad SA. Venous air embolism. 2006. Available from: http://www.emedicine.com/emerg/topic787.htm.
2. Ho AM, Ling E. Systemic air embolism after lung trauma. Anesthesiology 1999; 90:564-75.
3. de Jong KIF, de Leeuw PW. Venous carbon dioxide embolism during laparoscopic cholecystectomy a T literature review. European Journal of Internal Medicine 2019; 60:9-12
4. Matteia P, Tylerb DC. Carbon dioxide embolism during laparoscopic cholecystectomy due to a patent paraumbilical vein. Journal of Pediatric Surgery 2007; 42:570-72.
5. Toung TJK, Rossberg MI, Hutchins GM. Volume of air in a lethal venous air embolism. Anesthesi-ology 2001; 94:360-1
6. Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007; 106:164-77.
7. Bedell EA, Berge KH, Losasso TJ. Paradoxic air embolism during venous air embolism: transesopha-geal echocardiographic evidence of transpulmonary air passage. Anesthesiology 1994; 80:947-50.
8. Schneider B, Zienkiewicz T, Jansen V, Hofmann T, Noltenius H, Meinertz T. Diagnosis of patent fora-men ovale by transesophageal echocardiography and correlation with autopsy findings. American Journal of Cardiology 1996; 77:1202-9.
9. Dion YM, Lévesque C, Doillon CJ. Experimental carbon dioxide pulmonary embolization after vena cava laceration under pneumoperitoneum. Surgical Endoscopy 1995; 10:1065-9.
10. Mayer KL, Ho HS, Mathiesen KA, Wolfe BM. Cardiopulmonary responses to experimental venous car-bon dioxide embolism. Surgical Endoscopy 1998; 12:1025-30.
11. Kapurch CJ, Abcejo AS. The relationship between end-expired carbon dioxide tension and severity of venous air embolism during sitting neurosurgical procedures – a contemporary analysis. Journal of Clinical Anesthesia 2018; 51:49-54
12. Kim CS, Kim JY, Kwon JY, Choi SH, Na S, An J, Kim KJ. Venous air embolism during total laparoscopic hysterectomy comparison to total abdominal hysterectomy. Anesthesiology 2009; 111:50-54.

(Abstract) (Text HTML) (Download PDF)