PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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).
METHODS: Although a decrease in end-tidal carbon dioxide (ETCO2) was not observed, CO2 embolism was still suspected because of the symptoms.
RESULTS: 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.
CONCLUSIONS: Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
METHODS: 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).
METHODS: Although a decrease in end-tidal carbon dioxide (ETCO2) was not observed, CO2 embolism was still suspected because of the symptoms.
RESULTS: 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.
CONCLUSIONS: Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
摘要：
背景：腹腔镜肝切除术（LH）由于广泛的肝横切导致二氧化碳栓塞的高风险，手术持续时间长,解剖大肝静脉或腔静脉。
方法：一名65岁男子计划接受LH治疗。腹膜内二氧化碳（CO2）吹气和肝门阻塞后，患者出现严重的血流动力学塌陷,并伴有脉搏血氧饱和度(SpO2)下降.
方法：尽管未观察到潮气末二氧化碳（ETCO2）的减少，由于症状，仍怀疑CO2栓塞。
结果：患者在立即停止CO2吹入和服用强效剂后成功复苏。在腹腔镜手术期间，每当发生与脉搏氧饱和度降低相关的突然血流动力学崩溃时，必须始终怀疑CO2栓塞。无论ETCO2是否发生变化。即时动脉血气分析势在必行，PaCO2和ETCO2之间的显着差异表明二氧化碳栓塞。
结论：即时动脉血气分析势在必行，PaCO2和ETCO2之间的显着差异表明二氧化碳栓塞。
方法：一名65岁男子计划接受LH治疗。腹膜内二氧化碳（CO2）吹气和肝门阻塞后，患者出现严重的血流动力学塌陷,并伴有脉搏血氧饱和度(SpO2)下降.
方法：尽管未观察到潮气末二氧化碳（ETCO2）的减少，由于症状，仍怀疑CO2栓塞。
结果：患者在立即停止CO2吹入和服用强效剂后成功复苏。在腹腔镜手术期间，每当发生与脉搏氧饱和度降低相关的突然血流动力学崩溃时，必须始终怀疑CO2栓塞。无论ETCO2是否发生变化。即时动脉血气分析势在必行，PaCO2和ETCO2之间的显着差异表明二氧化碳栓塞。
结论：即时动脉血气分析势在必行，PaCO2和ETCO2之间的显着差异表明二氧化碳栓塞。
