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Erschienen in: Intensive Care Medicine 3/2022

Open Access 14.09.2021 | Imaging in Intensive Care Medicine

Paradoxical carbon dioxide embolism during laparoscopic nephrectomy

verfasst von: Chun Ma, Dan Xu

Erschienen in: Intensive Care Medicine | Ausgabe 3/2022

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A 64-year-old female underwent laparoscopic nephrectomy for a kidney carcinoma. Amid the operation, the end-tidal carbon dioxide dropped from 39 to 22 mmHg. The expected wake at the end of the procedure did not achieve. The magnetic resonance imaging demonstrated diffuse lesions with restricted diffusion localized in the intracerebral parenchyma (Fig. 1). Paradoxical carbon dioxide embolism was diagnosed. No signs of right-to-left shunting were detected by transesophageal echocardiography. The patient was given Rivaroxaban for anticoagulant therapy. The patient remained in a coma 20 days before she recovered. During the hospitalization, the patient developed acute appendicitis and lung infection. After 60 days, the patient was discharged from the hospital, but there were some abnormalities in cognitive function, balance dysfunction, swallowing dysfunction, speech disorder, normal muscle strength of the limbs, and grade 4 muscle strength of the right lower limb.
Cerebral infarction resulting from paradoxical carbon dioxide embolism is a rare complication of laparoscopic surgery. In this case, the possible pathophysiology may be that the potential right-to-left shunt opened during the operation.

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Conflict of interests

The authors have no conflict of interests to declare.
The patient’s family provided consent for the publication of the images.
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Metadaten
Titel
Paradoxical carbon dioxide embolism during laparoscopic nephrectomy
verfasst von
Chun Ma
Dan Xu
Publikationsdatum
14.09.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 3/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-021-06525-9