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Minerva Anestesiologica 2000 January-February;66(1-2):63-7

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English

Presumptive delayed gas embolism after laparoscopic cholecystectomy

Capuzzo M., Buccoliero C., Verri M., Gritti G., Alvisi R.

From the Department of Biomedical Sciences and Advanced Therapy Section of Anaesthesiology and Intensive Care University Hospital, Ferrara *Division of Anaesthesia and Intensive Care University Hospital, Padova


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A 50-­year-old wom­an, ­with a his­to­ry of arte­ri­al hyper­ten­sion treat­ed ­with ­beta-block­er and Ca-antag­o­nist, pre­sent­ed car­diac ­arrest 6 ­hours ­after elec­tive lapar­os­cop­ic chol­e­cys­tec­to­my. During sur­gi­cal inter­ven­tion, arte­ri­al hypo­ten­sion with­out any res­pir­a­to­ry ­change was ­observed. Dyspnea, asthe­nia and anx­ie­ty ­were the clin­i­cal ­signs appear­ing approx­i­mate­ly 2 ­hours ­before car­diac ­arrest. After resus­ci­ta­tion, myo­car­dial infarc­tion, dis­sect­ing tho­rac­ic aor­tic aneu­rysm and ­major pul­mo­nary throm­boem­bo­lism ­were exclud­ed. The ­signs of ­increased resis­tance to the ­right ven­tric­u­lar out­flow and the rel­e­vant alter­a­tion of coag­u­la­tion ­tests, last­ing ­only a few ­hours, sug­gest­ed ­venous gas embo­lism. Subsequently, the ­patient pre­sent­ed a cor­ti­cal blind­ness, per­sist­ing at hos­pi­tal dis­charge. The anes­the­tists ­should be ­aware ­about the com­pli­ca­tion ­that we ­observed ­after lapar­os­cop­ic sur­gery. The ­least ­sign of car­di­o­res­pir­a­to­ry instabil­ity appear­ing in the post­op­er­a­tive peri­od ­must be tak­en ­into ­account and sig­nal the ­need for ­increased mon­i­tor­ing.

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