title: Venous gas embolism: An unusual complication of laparoscopic cholecystectomy.
abstract: Venous gas embolism (VGE) is a rare but potentially lethal complication of many forms of surgery, especially posterior fossa neurosurgery where the incidence is reported to be up to 80% - it can also occur in laparoscopic surgery. It usually occurs early in the procedure during insufflation of the abdomen. Rapid entry or large volumes of gas entering the venous circulation initiate a predictable chain of pathophysiological events which may continue to cardiovascular collapse. Arterial hypoxaemia, hypercapnia, decreased end-tidal CO(2), arrhythmias, myocardial ischaemia and elevated central venous and pulmonary arterial pressures can occur. The management of VGE relies on a high index of suspicion and close liaison between anaesthetist, surgeon and theatre staff. The authors present a case of venous gas embolism (VGE) during laparoscopic cholecystectomy (LC) which presented without many of the usual clinical features and was diagnosed by auscultation of a millwheel murmur.
authors.affiliation: Department of anaesthetics, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2PS, England.
authors.forename: Tim N
authors.initials: TN
authors.lastname: Wenham
authors.forename: Donald
authors.initials: D
authors.lastname: Graham