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Anesthesia

Air embolism in heart

07/26/2007

Question:

Last year my ectopic pregnancy was overlooked by my Gyno, despite only having one tube, and this being somewhat damaged from endometrosis and surgery nearly 20 years ago. Having been tested and found to be pregnant, by HCG levels were NOT rising as they should. Anyway, despite 2 weeks of bleeding and agony, my gyno then thought a laproscope might be in order! after my repeated `whinging` and previous gyno history. Apparently whilst in surgery carbon dioxide was blown into my heart which started to `suck` on air. The gyno said nothing after the event, and my husband `caught` the anesthestist afterwards in recovery as I had betadine and a bruise in my neck where they had put a shunt into my nect to suck gas out, which they bent anyway in the process, however the gas by then had expiled. Am I lucky? and who was responsible for this `slight complication` as the anesthestist put it. The surgeon or the anesthestist? I haven`t been told anything and I am just left guessing. I have been left wondering what exactly did happen in theatre this day.

Answer:

During a laparoscopic surgical procedure carbon dioxide (CO2) is pumped into the belly. This creates space within the abdomen for the surgeon to see the internal organs and to perform the surgery.

During this procedure, CO2 is absorbed continually in small amounts into the blood stream, and is safely expired via the lungs, along with body's normal load of CO2 produced by the tissues. At the end of the procedure the remaining gas is expelled from the small incisions in the belly. Some patients have shoulder tip pain after such procedures, which is thought to be due to irritation of the diaphragm, but most patients experience no harm at all from the CO2 gas.

Occasionally however, a large amount of CO2 can enter an internal blood vessel all at once - this is known as an embolism. A large embolism can cause problems with the flow of blood through the heart and lungs. The blood pressure may drop, and circulation to the body is decreased. An air embolism can be a fatal event, but a CO2 embolism, fortunately, does not usually cause much harm because the CO2 is rapidly absorbed into the tissues and exhaled.

One of the recommended treatments in the case of a severe air embolism is the insertion of a central venous catheter, the tip of which reaches all the way into the right atrium of the heart. From here, air (or CO2) can be sucked out. This may be the event that you are describing.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University