Suspect carbon dioxide embolism during retroperitoneoscopic adrenalectomy

Area of Science:

• Anesthesiology
• Surgical Complications
• Minimally Invasive Surgery

Background:

• Retroperitoneoscopic adrenalectomy is a minimally invasive surgical technique.
• Patient positioning in the prone position during surgery can present unique challenges.

Observation:

• A sudden increase in end-tidal CO2 (EtCO2) from 42 to 68 mmHg, followed by a sharp decrease to 35 mmHg, was observed during a retroperitoneoscopic adrenalectomy.
• This event coincided with a right adrenal vein laceration, leading to decreased heart rate (30 bpm) and systolic blood pressure (40 mmHg).

Findings:

• The patient's condition stabilized after repositioning and administration of vasoactive drugs, with progressive improvement in blood pressure, EtCO2, CO2 elimination (VCO2), and oxygen saturation (SpO2).
• End-tidal CO2 monitoring is crucial for detecting potential CO2 embolism during laparoscopic procedures.

Implications:

• This case highlights the potential for gas embolism during retroperitoneoscopic adrenalectomy.
• Acute, significant fluctuations in EtCO2 serve as an early warning sign for clinicians to suspect and manage this rare, life-threatening complication.