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.

Fig. 1

Carbon dioxide emboli detected by transesophageal echocardiography in a patient undergoing total laparoscopic hysterectomy; mid-esophageal four chamber view. (A) A single gas bubble in the right atrium (RA), right ventricle (RV), and right ventricle outflow tract (RVOT) (grade I). (B) gas bubbles filling less than half the diameter of RA, RV, and RVOT (grade II). (C) gas bubbles filling more than half the diameter of RA, RV, and RVOT (grade III). (D) gas bubbles completely filling the diameter of RA, RV, and RVOT (grade IV). Permission from Kim, et al.