Seesawing end-tidal carbon dioxide: portent of critical carbon dioxide embolism in retroperitoneoscopy
| Autor: | Mazhuvanchary Jacob Paul, Riya Jose, Melvin Alex Abraham |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Pituitary disorder
medicine.medical_treatment Inferior vena cava Young Adult 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Tidal Volume medicine Embolism Air Humans 030212 general & internal medicine Intraoperative Complications ST depression Adrenal Hyperplasia Congenital medicine.diagnostic_test business.industry Adrenalectomy General Medicine Carbon Dioxide medicine.disease Pulse oximetry Blood pressure Embolism medicine.vein Anesthesia Female Laparoscopy medicine.symptom business Central venous catheter Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect |
| Zdroj: | BMJ Case Reports. :bcr-2017 |
| ISSN: | 1757-790X |
| Popis: | An abrupt increase in end-tidal CO(2) (EtCO(2); 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, EtCO(2), 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 EtCO(2) should alert the anaesthesiologist to this rare but potentially fatal complication. |
| Databáze: | OpenAIRE |
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