Carbon dioxide embolism during pneumoperitoneum for laparoscopic surgery: a case report

Although rare, a carbon dioxide (CO2) embolism is a potential complication of laparoscopic surgery. An embolism may occur during insufflation of the abdomen after incorrect placement of a Veress needle into a vascular organ or an intra-abdominal vessel. If the CO2 embolism is not recognized, it can be rapidly fatal for the patient unless the patient receives treatment immediately. Therefore, anesthesia providers must be vigilant while monitoring, recognize when an embolism has occurred, and be able to provide effective management and treatment for their patient. This case report describes a 34-year-old woman who underwent a suction dilation and curettage, followed by an exploratory laparoscopic procedure to examine her uterus. After placement of the Veress needle and insufflation of the abdomen, a CO2 embolism developed that caused severe hypotension, bradycardia, and loss of end-tidal CO2 tracing. The patient was treated quickly and aggressively with fluid administration and intravenous vasopressors. Because of rapid recognition and treatment the patient did not suffer any long-term adverse medical events.