Occurrence of a carbon dioxide embolism during laparoscopic pyloromyotomy in a small child: several unresolved questions.

摘要

We read with great interest the article by Drs. Taylor and Hoffman who reported the case of a major carbon dioxide (CO_2) embolism in a two-week-old neonate during laparoscopic pyloromyotomy. This case raises several issues. First, the authors stated that there are sporadic reports of deaths in humans associated with massive CO_2 embolism; however, it is important to bear in mind that recent studies performed in adult patients have shown a high prevalence of gas embolism during laparoscopic procedures when using transesophageal echocardiography as the diagnostic tool. All patients undergoing total laparoscopic hysterectomy suffered a right atrial gas embolism, and one-third of these underwent a high-grade gas embolism. Seventeen percent of patients undergoing a laparoscopic radical prostatectomy also suffer a right atrial gas embolism.