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Can J Anesth/J Can Anesth (2010) 57:774778
DOI 10.1007/s12630-010-9320-6
CASE REPORTS/CASE SERIES
Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant
Embolie gazeuse et arrt cardiaque pendant une pylorotomie laparoscopique chez un nourrisson
Susan P. Taylor, MD George M. Hoffman, MD
Received: 22 February 2010 / Accepted: 15 April 2010 / Published online: 30 April 2010 Canadian Anesthesiologists Society 2010
AbstractPurpose High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufation 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 insufation of the abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide (CO2ET) 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 ve 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 patients 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 insufation 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.
RsumObjectif Une tubulure de grand volume est utilise pour fournir du dioxyde de carbone pendant les interventions par laparoscopie. A`dfaut de purger la tubulure avec du dioxyde de carbone avant linsufation abdominale, de lair azot pourrait tre entran dans la cavit abdominale. Nous signalons un cas o linsufation initiale de gaz par voie intrapritonale a entran un collapsus cardiovasculaire immdiat ncessitant des manuvres prolonges de ranimation....