title: Paradoxical carbon dioxide embolism during laparoscopic cholecystectomy as a cause of cardiac arrest and neurologic sequelae: a case report.
abstract: An 81-year-old male patient was scheduled for a laparoscopic cholecystectomy due to acute cholecystitis. About 50 minutes into the operation, the arterial blood pressure suddenly decreased and ventricular fibrillation appeared on the electrocardiography. The patient received cardiopulmonary resuscitation and recovered a normal vital sign. We suspected a carbon dioxide embolism as the middle hepatic vein had been injured during the surgery. We performed a transesophageal echocardiography and were able to confirm the presence of multiple gas bubbles in all of the cardiac chambers. After the operation, the patient presented a stable hemodynamic state, but showed weaknesses in the left arm and leg. There were no acute lesions except for a chronic cerebral cortical atrophy and chronic microvascular encephalopathy on the postoperative brain-computed tomography, 3D angiography and magnetic resonance image. Fortunately, three days after the operation, the patient's hemiparesis had entirely subsided and he was discharged without any neurologic sequelae.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Shin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Ju Deok
authors.initials: JD
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Soo Bong
authors.initials: SB
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Doo Sik
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Kyung Han
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Sie Jeong
authors.initials: SJ
authors.lastname: Ryu
keywords: Carbon dioxide embolism; Cardiopulmonary resuscitation; Paradoxical embolism; Transesophageal echocardiography