Re-insufflation after deflation of a pneumoperitoneum is a risk factor for CO(2) embolism during laparoscopic prostatectomy -A case report

Although symptomatic carbon dioxide (CO(2)) embolism is rare, it recognized as a potentially fatal complication of laparoscopic surgery. Sudden hemodynamic instability could be a CO(2) embolism especially during insufflation. A 65-year-old man received laparoscopic prostatectomy for 5 hours under CO(2) pneumoperitoneum without any problem. After resection of prostate, it was stopped following deflation. Thirty minutes later, peumoperitoneum was re-induced to continue the operation. Shortly after re-insufflation, the patient revealed hemodynamic instability suggested a CO(2) embolism; severe hypotension, tachyarrythmia, hypoxemia, increased CVP, and changed end-tidal CO(2). Gas insufflation was stopped. He was managed with Durant's position, fluid and cardiotonics for 20 minutes. The residual was completed by open laparotomy. Re-insufflation, inducing gas entry through the injured vessels, might be a risk factor for CO(2) embolism in this case. The risk to the patient may be minimized by the surgical team's awareness of CO(2) embolism and continuous intra-operative monitoring of end-tidal CO(2).