Air embolus associated with tubal insufflation

A patient underwent laparoscopy for a rectovaginal mass, dysmenorrhea, and infertility. After CO(2) pneumoperitoneum was established the laparoscope was placed without difficulty. Before the procedure was completed, the tubes were insufflated with air through a 20-ml syringe attached to a Cohen cannula. Tubes were patent. No other intraabdominal manipulation was performed at that time. During tubal insufflation the patient's end-tidal CO(2) decreased to 18%, partial pressure of oxygen decreased to 83%, and pulse increased to 130/minute. The CO(2) pneumoperitoneum was released, and the woman stabilized spontaneously. The CO(2) pneumoperitoneum was again established, with no further difficulty. The time relationship with tubal insufflation and lack of recurrence on reestablishing pneumoperitoneum suggest that air embolization during tubal insufflation occurred.