Ghimouz A, Loisel B, Kheyar M, Fried D, Bouret J M
Département d'anesthésie et de réanimation, hôpital Lariboisière, Paris, France.
Ann Fr Anesth Reanim. 1996;15(2):192-5. doi: 10.1016/0750-7658(96)85042-8.
A 43 year-old woman, with uterine bleeding and right ovary cyst, was scheduled for hysteroscopy-curettage and laparoscopy. Her history was unremarkable. After induction of general anaesthesia and tracheal intubation (propofol, fentanyl, vecuronium), anesthesia was maintained with N2O/O2 (60%/40%) and isoflurane 1 vol %. The patient was placed in the dorsal lithotomy position. Two minutes after the beginning of CO2 insufflation for hysteroscopy, a ventricular tachycardia with a circulatory arrest suddenly occurred. Insufflation was stopped, cardiopulmonary resuscitation started and lignocaine 100 mg iv administered. The haemodynamic status improved rapidly with a return to sinusal rhythm and stable blood pressure within two minutes. In the recovery room, the patient was restless and experienced blindness for 3 hours. Physical examination and all investigations (EEG, brain CT scan, carotid Doppler and transoesophageal echocardiography) were normal. The most probable diagnosis was a CO2 venous embolism associated with an arterial paradoxal embolism responsible for the temporary blindness.
一名43岁女性，因子宫出血和右侧卵巢囊肿，计划接受宫腔镜刮宫术和腹腔镜检查。她的病史无异常。在诱导全身麻醉并气管插管（丙泊酚、芬太尼、维库溴铵）后，用N2O/O2（60%/40%）和1%体积分数的异氟烷维持麻醉。患者置于膀胱截石位。在开始为宫腔镜检查注入二氧化碳两分钟后，突然发生室性心动过速并伴有循环骤停。停止注入，开始心肺复苏，并静脉注射100毫克利多卡因。血流动力学状态在两分钟内迅速改善，恢复窦性心律且血压稳定。在恢复室，患者烦躁不安并出现3小时失明。体格检查和所有检查（脑电图、脑部CT扫描、颈动脉多普勒检查和经食管超声心动图）均正常。最可能的诊断是二氧化碳静脉栓塞伴动脉矛盾栓塞导致暂时性失明。
