Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Department of Anesthesiology, Haining People's Hospital, Haining, Zhejiang Province, China.
Medicine (Baltimore). 2024 Jun 14;103(24):e38468. doi: 10.1097/MD.0000000000038468.
Laparoscopic hepatectomy (LH) poses a high risk of carbon dioxide embolism due to extensive hepatic transection, long surgery duration, and dissection of the large hepatic veins or vena cava.
A 65-year-old man was scheduled to undergo LH. Following intraperitoneal carbon dioxide (CO2) insufflation and hepatic portal occlusion, the patient developed severe hemodynamic collapse accompanied by a decrease in the pulse oxygen saturation (SpO2).
Although a decrease in end-tidal carbon dioxide (ETCO2) was not observed, CO2 embolism was still suspected because of the symptoms.
The patient was successfully resuscitated after the immediate discontinuation of CO2 insufflation and inotrope administration. CO2 embolism must always be suspected during laparoscopic surgery whenever sudden hemodynamic collapse associated with decreased pulse oxygen saturation occurs, regardless of whether ETCO2 changes. Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
由于广泛的肝切除术、手术时间长以及大肝静脉或腔静脉的分离，腹腔镜肝切除术 (LH) 存在二氧化碳栓塞的高风险。
一位 65 岁男性计划接受 LH。在腹腔内二氧化碳 (CO2) 充气和肝门阻断后，患者出现严重的血流动力学崩溃，伴有脉搏血氧饱和度 (SpO2) 下降。
尽管未观察到呼气末二氧化碳 (ETCO2) 下降，但由于出现症状，仍怀疑发生 CO2 栓塞。
立即停止 CO2 充气和使用正性肌力药后，患者成功复苏。无论 ETCO2 是否发生变化，只要在腹腔镜手术中发生与脉搏血氧饱和度降低相关的突然血流动力学崩溃，都应始终怀疑 CO2 栓塞。即时动脉血气分析至关重要，PaCO2 和 ETCO2 之间存在显著差异提示存在二氧化碳栓塞。
即时动脉血气分析至关重要，PaCO2 和 ETCO2 之间存在显著差异提示存在二氧化碳栓塞。
