title: Cardiac arrest in the neonate during laparoscopic surgery.
abstract: We describe a case of intraoperative neonatal cardiac arrest during attempted laparoscopic surgery. Circulatory collapse occurred before peritoneal insufflation, initially obscuring the diagnosis. Emergent transthoracic echocardiography during resuscitation demonstrated intracardiac gas bubbles consistent with venous gas embolism. The site of entrainment was probably a bleeding umbilical vein transected by the umbilical trocar. Greater awareness of this complication in neonates will facilitate early diagnosis and encourage preventive measures, such as the avoidance of umbilical vessels, use of an open instead of closed access technique, and ligation of bleeding vessels after peritoneal access.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR 97239, USA. lalwanik@ohsu.edu
authors.forename: Kirk
authors.initials: K
authors.lastname: Lalwani
authors.forename: Inger
authors.initials: I
authors.lastname: Aliason
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism; D004452:Echocardiography / Q000379:methods; D004618:Embolism, Air / Q000150:complications / Q000209:etiology*; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D007327:Insufflation / Q000009:adverse effects; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008991:Monitoring, Physiologic
chemical_list: D002245:Carbon Dioxide