Abstract
BackgroundCarbon dioxide embolism is a life-threatening complication of laparoscopic hepatectomy.Case presentationA 59-year-old man was admitted for laparoscopic hepatectomy. Approximately 5 h after commencing the operation, we observed a gradual decline in the SpO2 from 100 to 94%, reduction in the ETCO2 from 44 to 19 mmHg, reduction in the systolic blood pressure from 100 to 82 mmHg, and elevation of the heart rate from 82 to 120 beats/min. Intraoperatively, the image displayed on the laparoscopic monitor revealed a small tear in the vein. The inspired O2 fraction was raised to 1.0, intravenous phenylephrine (0.1 mg bolus) was administered, and the respiratory rate was increased. After the patient was stabilized, the injured vein was cut and sealed. After the embolic event, the entire operation was completed without complications.ConclusionsCareful observation of the laparoscopic monitor is important, particularly during establishment of pneumoperitoneum in patients undergoing laparoscopic hepatectomy.
Highlights
Carbon dioxide embolism is a life-threatening complication of laparoscopic hepatectomy.Case presentation: A 59-year-old man was admitted for laparoscopic hepatectomy
We describe Carbon dioxide (CO2) embolism that gas entry was confirmed on a laparoscopic monitor in a patient who underwent laparoscopic hepatectomy using the Pringle maneuver
5 h after commencing the operation and establishment of pneumoperitoneum, during the Pringle maneuver, we observed a gradual decline in the patient’s Oxygen saturation (SpO2) from 100 to 94%, reduction in the End-tidal carbon dioxide (ETCO2) from 44 to 19 mmHg, reduction in the systolic blood pressure from 100 to 82 mmHg, and rapid elevation of the heart rate from 82 to 120 beats/min (Fig. 1)
Summary
Laparoscopic hepatectomy is a minimally invasive procedure associated with lesser intraoperative bleeding and postoperative pain and faster recovery. Low central venous pressure (< 5 mmHg), high-pressure pneumoperitoneum (> 12 mmHg), and the Pringle maneuver are used to achieve hemostasis during laparoscopic hepatectomy [2]. The respiratory rate was adjusted to 8–16 breaths/min to maintain an ETCO2 pressure of 30–45 mmHg. After induction of anesthesia and tracheal intubation, a 22-G catheter was inserted into the left radial artery for blood sampling and continuous blood pressure monitoring. 5 h after commencing the operation and establishment of pneumoperitoneum, during the Pringle maneuver (hepatic resection performed with clamping the branches of the vascular pedicle), we observed a gradual decline in the patient’s SpO2 from 100 to 94%, reduction in the ETCO2 from 44 to 19 mmHg, reduction in the systolic blood pressure from 100 to 82 mmHg, and rapid elevation of the heart rate from 82 to 120 beats/min (Fig. 1). His postoperative course was uneventful, and he was discharged without further complications
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