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Cerebral infarction detected after laparoscopic partial hepatectomy: case report
Atsushi Kobayashi1, Kazuhiro Shirozu2, Yuji Karashima3
1Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
JA Clinical Reports
|February 7, 2020
Summary
Carbon dioxide gas embolism during laparoscopic surgery can lead to serious complications like cerebral infarction. This case highlights the importance of monitoring for gas embolism during laparoscopic hepatectomy to prevent neurological deficits.
Area of Science:
- Minimally invasive surgery
- Neurology
- Cardiology
Background:
- Laparoscopic surgery carries risks of bleeding and carbon dioxide (CO2) gas embolism.
- Cerebral infarction is a potential, serious complication.
- This case focuses on CO2 gas embolism during laparoscopic hepatectomy.
Purpose of the Study:
- To report a case of cerebral infarction.
- To investigate the presumed cause as CO2 gas embolism.
- To emphasize monitoring during laparoscopic procedures.
Main Methods:
- Monitoring end-tidal CO2 levels during liver resection.
- ECG monitoring for ST changes.
- Postoperative neurological examination and MRI.
Main Results:
- A sudden drop in end-tidal CO2 from 40 to 21 mmHg.
- Observed ECG changes (ST elevation/depression).
- Postoperative hemiparesis and confirmed cerebral infarction via MRI.
Conclusions:
- Cerebral infarction with neurological deficits is a risk in laparoscopic surgery.
- Paradoxical embolism is a potential mechanism.
- Vigilant monitoring and prompt treatment for gas embolism are crucial.
