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[Pulmonary embolism during laparoscopic cholecystectomy detected by sudden decrease in end-tidal carbon dioxide

Y Matsuoka1, S Kusunose, R Kitamura

  • 1Department of Anesthesia, Mitsubishi Kyoto Hospital, Kyoto 615-8087.

Masui. the Japanese Journal of Anesthesiology
|February 24, 2001
PubMed
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A sudden drop in end-tidal carbon dioxide pressure (PETCO2) during surgery can signal intraoperative pulmonary embolism. Continuous PETCO2 monitoring is recommended for early detection in laparoscopic procedures.

Area of Science:

  • Anesthesiology
  • Cardiopulmonary Physiology
  • Surgical Monitoring

Background:

  • Pulmonary embolism (PE) is a critical complication that can occur during surgery.
  • Early detection of intraoperative PE is crucial for patient outcomes.
  • Laparoscopic surgery presents unique challenges for monitoring cardiopulmonary events.

Observation:

  • A 56-year-old female patient developed a sudden decrease in end-tidal carbon dioxide pressure (PETCO2) from 34-38 mmHg to 24 mmHg.
  • Simultaneously, percutaneous oxygen saturation (SpO2) dropped from 99% to 95%.
  • Subcutaneous emphysema was noted upon removal of the surgical drape.

Findings:

  • The observed changes in PETCO2 and SpO2 were indicative of an intraoperative pulmonary embolism.
  • Postoperative pulmonary scanning confirmed areas of reduced pulmonary perfusion.

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  • The patient was treated with heparin and recovered without sequelae.

    • Implications:

    • Continuous end-tidal carbon dioxide pressure (PETCO2) monitoring is a valuable, non-invasive tool for detecting intraoperative pulmonary embolism during laparoscopic surgery.
    • This method offers an alternative to more invasive monitoring techniques like pulmonary artery catheterization.
    • Implementing routine PETCO2 monitoring can improve patient safety in minimally invasive procedures.