Carbon dioxide narcosis and grand mal seizure complicating laparoscopic herniorrhaphy.
A 60-year-old man without comorbidity underwent a totally extraperitoneal repair of bilateral inguinal hernias under general anesthesia. Forty minutes after the procedure he developed a slow, shallow respiratory pattern with a respiratory rate of 5/min and a self-limiting grand mal seizure lasting 30 seconds. Arterial blood gas analysis indicated significant hypercarbia and acidosis. The total dose of morphine administered was 20 mg intravenously. Naloxone was administered and the respiratory rate improved. The patient was discharged after 24 hours after making a good recovery and has had no further seizures a year after surgery. Although hypercarbia is a well-known complication of laparoscopic surgery when CO2 is used for insufflation, this, to the best of our knowledge, is the first reported case of a patient sustaining a grand mal seizure resulting from CO2 narcosis after laparoscopic surgery. The possible mechanisms are discussed.
Nunes
Quentin M
QM
Section of Surgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Gemmill
Elizabeth H
EH
Eastwood
Joanne R
JR
Lobo
Dileep N
DN
D001784:Blood Gas Analysis; D002245:Carbon Dioxide; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology*; D053608:Stupor / Q000139:chemically induced*
D009292:Narcotic Antagonists; D002245:Carbon Dioxide; D009270:Naloxone