Anesthetic Considerations for Carbon Dioxide Emboli in Patients with Obesity - A Case Report

Gas embolization is a rare but potentially deadly complication of any laparoscopic surgery. There has only been one other report of gas emboli in patients undergoing bariatric surgery. We present a case of gas embolization in a young female patient undergoing Roux-en-Y gastric bypass. Onset of gas embolus was identified by a dramatic drop in End Tidal Carbon Dioxide (ETCO2) followed by drops in blood pressure, heart rate, and oxygen saturation over the following 15 minutes before the patient was stabilized and transferred to the ICU. The surgery was completed three days later without incident, and extensive hepatomegaly was identified. A discussion on pre-operative evaluation, special considerations, and acute management of gas embolization in patients with obesity ensues. We highlight the emerging Jain's point for insufflation, the potential for ultrasound-guided Verres needle insertion, and the paucity of literature evaluating the risk, incidence, and outcomes of gas embolization in patients with obesity.