Article Text
Summary
An abrupt increase in end-tidal CO2 (EtCO2; from 35 to 58 mm Hg) followed by a sudden fall (to 18 mm Hg) was noted during retroperitoneoscopic adrenalectomy under general anaesthesia in a 23-year-old patient with adrenal hyperplasia. This was accompanied by hypotension (systolic blood pressure of 60 mm Hg), desaturation (88% SpO2) and ST depression (3.5 mm). The patient was resuscitated with fluids and vasopressor drugs and about 4 mL of air was aspirated through the central venous catheter, confirming the diagnosis of an intraoperative gas embolism. Later, a rent in the adrenal vein extending into the inferior vena cava was discovered and sutured. The blood pressure, EtCO2, ST segment and pulse oximetry returned to normal after 15 min. This case demonstrates that gas embolism may transpire during retroperitoneoscopic adrenalectomy and an acute rise followed by a sharp fall in EtCO2 should alert the anaesthesiologist to this rare but potentially fatal complication.
- anaesthesia
- pituitary disorders
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Footnotes
Contributors MAA was the anaesthesiologist for the reported case. The operating surgeon was MJP. RJ was instrumental in writing up the case report and preparation of the table and graph.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.