Faculty Collaboration Database

Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant. Can J Anaesth 2010 Aug;57(8):774-8

Date

05/01/2010

Pubmed ID

20431981

DOI

10.1007/s12630-010-9320-6

Scopus ID

2-s2.0-77955470273 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

PURPOSE: High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufflation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufflation of laparoscopic gas resulted in immediate cardiovascular collapse requiring prolonged resuscitation. Persistent intracranial emboli following the arrest may have resulted from nitrogen contamination of the delivered gas.

CLINICAL FEATURES: A 12-day-old female underwent laparoscopy for pyloric stenosis. During initial insufflation of the abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide (CO(2ET)) associated with bradycardia and pulseless electrical activity. Three hours after successful resuscitation and open pyloromyotomy, computerized tomography documented intra-arterial gas within the cerebral and hepatic circulations that resolved following hyperbaric oxygen therapy. Magnetic resonance imaging five days later revealed watershed infarcts in the right frontal and parietal regions. Nitrogen, an insoluble gas not easily eliminated from the body, was likely the gas present within the patient's circulation several hours after the event. It was unlikely carbon dioxide, which is a highly soluble gas that binds to hemoglobin and is rapidly buffered by the carbonic anhydrase system and excreted by the lung. Room air contamination of high volume insufflation tubing allows nitrogen to enter body cavities during endoscopic procedures.

CONCLUSION: Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures.

Author List

Taylor SP, Hoffman GM

Author

George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cerebral Ventriculography
Embolism, Air
Female
Heart Arrest
Humans
Hyperbaric Oxygenation
Infant, Newborn
Insufflation
Laparoscopy
Pyloric Stenosis
Resuscitation
Tomography, X-Ray Computed