[Diagnosis of heart arrest caused by CO2 embolism during laparoscopic surgery by monitoring of aortic blood flow and capnography].
We report the case of a 25-year-old woman undergoing a laparoscopic cholecystectomy, who suffered, one min after the beginning of intraperitoneal insufflation of CO2 (2.5 L at a pressure of 10 mmHg), a sudden decrease to 0.8 L.min-1 of the aortic blood flow (ABF), monitored in the descending aorta by an oesophageal echo-Doppler probe, associated with a decrease of PetCO2 to 15 mmHg and of SpO2 readings to 88%. Despite the lack of simultaneous changes in heart rate and arterial pressure, pulmonary gas embolism (GE) was suspected. The pneumoperitoneum was exsufflated and CPR was started because of circulatory inefficiency. Ten min later, efficient spontaneous cardiac activity restarted, whereas PetCO2 and ABF returned rapidly to normal values. At this time, a typical gas noise was clearly obtained through the oesophageal Doppler transducer. The patient remained in deep coma (GCS:6) with a left sided hemiplegia. However, she fully recovered after four sessions of hyperbaric oxygenation. Simultaneous continuous monitoring of ABF and PetCO2 allows an undelayed recognition of major circulatory disturbances, before significant changes in heart rate and arterial pressure occur.
Gueugniaud
P Y
PY
Service d'Anesthésie-Ránimation VII, Hôpital Edouard-Herriot, Lyon.
Bertin-Maghit
M
M
Petit
P
P
Muchada
R
R
D000328:Adult; D001011:Aorta / Q000503:physiopathology; D002245:Carbon Dioxide / Q000032:analysis; D002302:Cardiac Output; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D018608:Ultrasonography, Doppler
D002245:Carbon Dioxide
Diagnostic par surveillance du débit aortique et du capnogramme d'un arrêt circulatoire par embolie de CO2 au cours de la chirurgie laparoscopique.