title: Intraoperative management of a carbon dioxide embolus in the setting of laparoscopic cholecystectomy for a patient with primary biliary cirrhosis: A case report.
abstract: BACKGROUND
  Carbon dioxide (CO2) embolism is a rare complication of laparoscopic cholecystectomy of which both surgeons and anesthesiologists must be aware. This paper presents a case of a CO2 embolus that occurred in a patient with primary biliary cirrhosis (PBC) and discusses the possible correlation between these two events.
  
  
  METHODS
  Our patient with PBC presented with symptomatic biliary dyskinesia and was determined to be a good candidate for laparoscopic cholecystectomy. During this routine surgery a CO2 embolus entered through the altered hepatic parenchyma and progressed to the heart leading to acute hemodynamic collapse. Rapid detection and management aided in the subsequent dissolution of the embolus and recovery of the patient.
  
  
  CONCLUSIONS
  In patients with PBC, pathological changes that have taken place in the liver may increase the risk of CO2 embolism. Hepatic alterations that have been previously described include increased angiogenesis and vasodilation. Prior to the operation, the most appropriate method of monitoring should be determined for patients with known liver disease.
  
  
  CONCLUSIONS
  Both the surgical and anesthesia team must keep in mind the potential for CO2 embolism during laparoscopic surgery. It is imperative that the medical staff be aware of the risks, signs, and subsequent management so this rare, but potentially fatal event can be managed appropriately.
authors.affiliation: Texas A&M Health Science Center, College of Medicine, 8447 State HW 47, Bryan, TX 77807, United States. Electronic address: acadis@medicine.tamhsc.edu.
authors.forename: Amy Susan
authors.initials: AS
authors.lastname: Cadis
authors.affiliation: Texas A&M Health Science Center, College of Medicine, 8447 State HW 47, Bryan, TX 77807, United States. Electronic address: cbates@medicine.tamhsc.edu.
authors.forename: Chelsea Diane
authors.initials: CD
authors.lastname: Velasquez
authors.affiliation: Department of Anesthesiology, Texas A&M Health Science Center, College of Medicine, 8447 State HW 47, Bryan, TX 77807, United States. Electronic address: aggie1615@aol.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Brauer
authors.affiliation: General Surgery, Texas A&M Health Science Center, College of Medicine, 8447 State HW 47, Bryan, TX 77807, United States. Electronic address: hoak@medicine.tamhsc.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Hoak
keywords: Carbon dioxide embolism; Laparoscopic cholecystectomy; Primary biliary cirrhosis