DIAGNOSIS OF CIRCULATORY ARREST FROM CARBON-DIOXIDE EMBOLISM WITH AORTIC BLOOD-FLOW AND CAPNOGRAM MONITORING DURING LAPAROSCOPIC CHOLECYSTECTOMY

We report the case of a 25-year-old woman undergoing a laparoscopic cholecystectomy, who suffered, one min after the beginning of intraperitoneal insufflation of CO2 (2.5 L at a pressure of 10 mmHg), a sudden decrease to 0.8 L . min(-1) of the aortic blood flow (ABF), monitored in the descending aorta by an oesophageal echo-Doppler probe, associated with a decrease of PetCO(2) to 15 mmHg and of SpO(2) readings to 88%. Despite the lack of simultaneous changes in heart rate and arterial pressure, pulmonary gas embolism (GE) was suspected. The pneumoperitoneum was exsufflated and CPR was started because of circulatory inefficiency. Ten min later, efficient spontaneous cardiac activity restarted, whereas PetCO(2) and ABF returned rapidly to normal values. At this time, a typical gas noise was clearly obtained through the oesophageal Doppler transducer. The patient remained in deep coma (GCS : 6) with a left sided hemiplegia. However, she fully recovered after four sessions of hyperbaric oxygenation. Simultaneous continuous monitoring of ABF and PetCO(2) allows an undelayed recognition of major circulatory disturbances, before significant changes in heart rate and arterial pressure occur.