Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery

Abstract

Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently the patient developed one more episode of cardiac arrest but still made a full recovery. The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient.

Venous air embolism during cystoscopy in standing horses

“…; Kjeld et al . ), although recent studies in a swine model did not demonstrate improved neurological outcomes (Weenink et al . ).…”

“…), laparoscopy (Kjeld et al . ), and intestinal, gastric and rectal endoscopy (Ha et al . ; Chen et al .…”

Venous air embolism in neurosurgery

“…18 Hyperbaric oxygen reduces the size of the bubbles by promoting nitrogen reabsorption and the passage of dissolved oxygen into the blood. 49 The use of hyperbaric oxygen has been more common in arterial air embolism in the brain. There are also a few cases reported in the literature using spontaneous ventilation during neurosurgical procedures with the patient in the sitting position and the use of echocardiography with positive results.…”

Embolismo aéreo venoso en neurocirugía

“…El oxígeno hiperbárico reduce el tamaño de las burbujas al favorecer la reabsorción de nitrógeno y favorece el paso de oxígeno disuelto a la sangre 49 . El uso de oxígeno hiperbárico se ha aplicado más al embolismo aéreo arterial a nivel cerebral.…”