A case of a massive carbon dioxide embolism developing during laparoscopic hepatectomy which resulted in hemodynamic collapse and acute cerebral infarction

抄録

An 84-year-old man diagnosed with hepatocellular carcinoma was scheduled to undergo laparoscopic hepatic segmentectomy under general anesthesia combined with epidural analgesia. At 3 hours after the start of the operation, his arterial blood pressure, SpO₂ and EtCO₂ significantly decreased during resection of the liver, while CVP increased from 7 mmHg to 14 mmHg. The hemodynamic status stabilized within approximately 15 minutes, with the discontinuation of pneumoperitoneum, volume loading, and a single administration of noradrenaline. Surgery was then continued. Postoperatively, incomplete paralysis of the left face, left upper, and lower limbs was observed. MRI on the day after surgery revealed scattered lesions of acute cerebral infarction in the right cerebral hemisphere. The paralysis improved with rehabilitation until postoperative day 20. It is important to recognize that laparoscopic hepatectomy is risk factor for carbon dioxide embolism and anesthesia management should be conducted with consideration of the risk of carbon dioxide embolism.