Carbon dioxide embolization and laparoscopic cholecystectomy

The risk of venous air or CO2 embolization during laparoscopic biliary procedures is unknown. Sixty-one consecutive patients undergoing laparoscopic cholecystectomy at La Crosse Lutheran Hospital/Gundersen Clinic were monitored by precordial Doppler ultrasound and end-tidal capnography to determine the risk of gas embolization. Patients ranged in age from 19 to 77 years (mean, 47 years). No venous embolization was detected by Doppler ultrasound or capnography. The highest end-tidal CO2 ranged from 34 to 53 mm Hg (mean, 41 mm Hg). No patient demonstrated an abrupt change in end-tidal CO2. No significant intraoperative hemodynamic changes occurred, and no postoperative neurologic defects developed. We caution the surgical community to remain alert concerning the possibility of venous gas embolization as newer laparoscopic procedures are developed that may have increased risks of embolization.