title: Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery.
abstract: Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently the patient developed one more episode of cardiac arrest but still made a full recovery. The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient.
authors.affiliation: Department of Cardiology, University of Copenhagen, Herlev Hospital, Herlev Ringvej, 100 DK-2730, Denmark. thomaskjeld@dadlnet.dk
authors.forename: Thomas
authors.initials: T
authors.lastname: Kjeld
authors.forename: Egon G
authors.initials: EG
authors.lastname: Hansen
authors.forename: Nana G
authors.initials: NG
authors.lastname: Holler
authors.forename: Henrik
authors.initials: H
authors.lastname: Rottensten
authors.forename: Ole
authors.initials: O
authors.lastname: Hyldegaard
authors.forename: Eric C
authors.initials: EC
authors.lastname: Jansen
mesh_terms: D002245:Carbon Dioxide; D003560:Cysts / Q000601:surgery*; D004618:Embolism, Air / Q000209:etiology*; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D006931:Hyperbaric Oxygenation; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000009:adverse effects*; D008107:Liver Diseases / Q000601:surgery*; D008875:Middle Aged; D012008:Recurrence; D014680:Veins
chemical_list: D002245:Carbon Dioxide