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Successful Resuscitation After Carbon Dioxide Embolism During Laparoscopic Cholecystectomy

机译:腹腔镜胆囊切除术中二氧化碳栓塞后成功复苏

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Laparoscopic surgery is preferred since it shortens stay in hospital, lessens postoperative pain and complications, and because of the cosmetic advantages. Laparoscopic cholecystectomy surgery was planned for a 27 year old female patient, who was 110 kg and 167 cm tall. During the preoperative physical examination nothing was determined other than the morbid obesity (BMI:39). CO2 insuflation was started by using a Veress needle under the belly. When desaturation and frequent ventricular early fibrillation developed, CO2 insuflation was immediately stopped. Since the arrhythmias of the patient continued, 100 mg of lidocaine i.v. was applied and 100% of O2 was started. The table was positioned as trendelenbrug and it was turned to left. Bradycardia and cardiac arrest developed in the patient whose SpO2 was measured at 65% when desaturation increased. Immediately 1 mg of atropin and 1 mg of adrenalin i.v. was given and cardiopulmonary resuscitation and external cardiac massage was applied. After giving totally 4 mg of adrenalin in a number of doses, sinus tachycardia developed in the approximately 20th minute of the resuscitation. The patient was extubated and taken to intensive care nearly 60 minutes after the induction. In the abdominal USG done during the postoperative early phase, no free liquid was determined in the abdomen. Postoperative blood counts were stabilized. The patient was discharged the next day, and 3 months later, a nonproblematic laparoscopic cholecystectomy surgery was done.
机译:腹腔镜手术是优选的,因为它可以缩短住院时间,减轻术后的疼痛和并发症,并且具有美容的优点。计划对一名110岁,身高167 cm的27岁女性患者进行腹腔镜胆囊切除术。在术前体格检查期间,除了病态肥胖(BMI:39)外,没有发现其他任何东西。通过在腹部下使用Veress针开始进行CO2充气。当脱饱和并频繁发生心室早期纤颤时,立即停止了CO2充气。由于患者的心律不齐持续,因此,利多卡因静脉注射100 mg。施加氧气并开始100%的氧气。桌子被定位为Trendelenbrug,并向左旋转。当饱和度降低时,SpO2测得为65%的患者出现了心动过缓和心脏骤停。立即静脉注射1毫克的Atropin和1毫克的肾上腺素。进行了心肺复苏和体外心脏按摩。在多次给予总计4 mg的肾上腺素后,在复苏的大约20分钟内出现窦性心动过速。入院后将近60分钟,将患者拔管并接受重症监护。在术后早期进行的腹部USG检查中,腹部没有游离液体。术后血细胞计数稳定。患者第二天出院,三个月后进行了无问题的腹腔镜胆囊切除术。

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