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Venous carbon dioxide embolism during laparoscopic cholecystectomy a literature review

  • Kiki I.F. de Jong
    Affiliations
    Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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  • Peter W. de Leeuw
    Correspondence
    Corresponding author at: Department of Medicine, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, the Netherlands.
    Affiliations
    Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Published:October 20, 2018DOI:https://doi.org/10.1016/j.ejim.2018.10.008

      Abstract

      Laparoscopy has become the procedure of choice for routine gallbladder removal. A serious complication of this technique is the occurrence of gas emboli due to insufflation. It is associated with a high mortality rate of around 28%. The present systematic review intends to provide more insight into causes, symptoms and risk factors for this specific complication and to explore which measures should be taken to treat and prevent it. The Cochrane library and Pubmed were used as sources. Articles and their references were selected when they were related to the subject in sufficient detail.
      The course of this complication can vary from asymptomatic up to impairment of normal flow through the right ventricle (RV) or pulmonary artery, potentially leading to acute heart failure. The severity depends on the amount of gas, the rate of accumulation and the ability to remove the gas bubbles. It is difficult to estimate the true incidence of venous gas embolism during laparoscopic cholecystectomy as there are various diagnostic tools, each with different sensitivity. Precautions that need to be taken are: correct positioning of the needle, low insufflation pressure, low insufflation speed, screening for hypovolemia, Trendelenburg positioning, availability of intervention equipment at operation table, no placement of venous catheters during inspiration and catheter removing during expiration.
      Physicians need to be more aware of this harmful complication and the preventative measurements that need to be taken. As there are virtually no prospective data, future studies are needed to gain more knowledge on gas emboli during laparoscopic cholecystectomy.

      Keywords

      Abbreviations:

      CVP (Central Venous Pressure), ETCO2 (End Tidal Carbon Dioxide), ETN2 (End Tidal Nitrogen), HBOT (Hyperbaric oxygen therapy), mPAP (mean Pulmonary Artery Pressure), PEEP (Positive End Expiratory Pressure), SvO2 (Mixed Venous Oxygen Saturation), TEE (Trans Esophageal Echocardiography), TTE (Trans Thoracic Echocardiography)
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