Seesawing end-tidal carbon dioxide: portent of critical carbon dioxide embolism in retroperitoneoscopy. (23rd January 2018)

• Record Type: Journal Article
• Authors: Abraham, Melvin Alex; Jose, Riya; Paul, Mazhuvanchary Jacob
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-01-23
• Subjects: anaesthesia -- pituitary disorders; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2017-219397
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : An abrupt increase in end-tidal CO2 (EtCO2 ; from 35 to 58 mm Hg) followed by a sudden fall (to 18 mm Hg) was noted during retroperitoneoscopic adrenalectomy under general anaesthesia in a 23-year-old patient with adrenal hyperplasia. This was accompanied by hypotension (systolic blood pressure of 60 mm Hg), desaturation (88% SpO2) and ST depression (3.5 mm). The patient was resuscitated with fluids and vasopressor drugs and about 4 mL of air was aspirated through the central venous catheter, confirming the diagnosis of an intraoperative gas embolism. Later, a rent in the adrenal vein extending into the inferior vena cava was discovered and sutured. The blood pressure, EtCO2, ST segment and pulse oximetry returned to normal after 15 min. This case demonstrates that gas embolism may transpire during retroperitoneoscopic adrenalectomy and an acute rise followed by a sharp fall in EtCO2 should alert the anaesthesiologist to this rare but potentially fatal complication.