Carbon dioxide embolism with severe hypotension as an initial symptom during laparoscopy: a case report

Laparoscopy is widely used because it induces minimal postoperative pain and facilitates rapid recovery. However, carbon dioxide (CO(2)) embolism is a rare but potentially fatal complication of laparoscopic surgery. Earlier reports have shown that decreased end-tidal CO(2) (ETCO(2)) and increased partial pressure of CO(2) might be useful indicators of CO(2) embolism. We herein report a case of CO(2) embolism after the freed bladder neck was released during laparoscopic radical prostatectomy. Sudden hemodynamic disorder and increased ETCO(2) combined with immediate arterial blood gas analysis led us to suspect CO(2) embolism, which was confirmed by the aspiration of foamy blood from the central venous catheter. The patient was successfully resuscitated and recovered well. This case illustrates that hemodynamic collapse accompanied by increased ETCO(2) can indicate CO(2) embolism.