title: Suspect carbon dioxide embolism during retroperitoneoscopic adrenalectomy.
abstract: During a retroperitoneoscopic adrenalectomy in the prone position, a sudden increase in end-Tidal CO2 (EtCO2) (from 42 to 68 mmHg) followed by an abrupt decrease (from 68 to 35 mmHg) was observed, concomitantly with a right adrenal vein laceration. Heart rate decreased to 30 bpm, and the systolic blood pressure decreased to 40 mmHg. The patient was slightly turned in the left lateral and Trendelenburg position and vasoactive drugs were administered. The systemic blood pressure, EtCO2, CO2 elimination (VCO2) and pulse oximetry (SpO2) progressively improved within 10 minutes and, at the end of the surgery, the blood pressure recovered from hypotension. ECG returned to normal, with sinusal rhythm and heart rate approximately 70 bpm. The patient was extubated and moved to the Intensive Care Unit (ICU). This case suggests that gas embolisms may occur during retroperitoneoscopic adrenalectomy, and acute changes in EtCO2 should alert the clinicians to these rare but potentially lethal complication. EtCO2 monitoring is essential during laparoscopy, as it may help an early detection of CO2 embolism, characterized by a transient and rapid increase in EtCO2, followed by an abrupt decrease.
authors.affiliation: Department of Anaesthesiology and Intensive Care, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. liliana.sollazzi@rm.unicatt.it
authors.forename: L
authors.initials: L
authors.lastname: Sollazzi
authors.forename: V
authors.initials: V
authors.lastname: Perilli
authors.forename: G
authors.initials: G
authors.lastname: Punzo
authors.forename: P
authors.initials: P
authors.lastname: Ciocchetti
authors.forename: M
authors.initials: M
authors.lastname: Raffaelli
authors.forename: R
authors.initials: R
authors.lastname: Bellantone
authors.forename: C P
authors.initials: CP
authors.lastname: Lombardi
mesh_terms: D000315:Adrenalectomy / Q000009:adverse effects* / Q000379:methods; D000328:Adult; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects* / Q000032:analysis; D004618:Embolism, Air / Q000209:etiology*; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D010092:Oximetry; D016684:Prone Position; D012187:Retroperitoneal Space
chemical_list: D002245:Carbon Dioxide