Asploro Journal of Biomedical and Clinical Case Reports

Asploro Journal of Biomedical and Clinical Case Reports

Bo Xu^1,2, Rurong Wang^1ID*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
²Department of Anesthesiology, Cheng Du Shangjin Nanfu Hospital, Chengdu, Sichuan, China

Corresponding Author: Rurong Wang ^{ORCID iD}
Address: Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
Received date: 16 August 2023; Accepted date: 25 August 2023; Published date: 01 September 2023

Citation: Xu B, Wang R. A Case of Air Embolism during Transoral Vestibular Endoscopic Thyroidectomy. Asp Biomed Clin Case Rep. 2023 Sept 01;6(3):222-28.

Copyright © 2023 Xu B, Wang R. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Air Embolism, Pulmonary Embolism, Thyroidectomy, Endoscopy

Abstract

Background: Carbon dioxide (CO₂) embolism is a rare but potentially life-threatening complication of endoscopic surgery. While endoscopic thyroidectomy is superior to traditional open thyroidectomy in terms of cosmetic results, it may lead to venous or fatal paradoxical CO₂ embolism. CO₂ embolism involves the inadvertent injection of carbon dioxide into a large vein, artery, or solid organ. The clinical manifestations of CO₂ embolism can vary from asymptomatic to neurological damage, cardiac failure, and even death, depending on the rate and volume of CO₂ entry and the patient’s general condition. This case can enhance our understanding of CO₂ embolization during endoscopic surgery.
Case Presentation: This case report describes an incident in which a gas embolism occurred during endoscopic right lobe and isthmus thyroidectomy, resulting in arrhythmia and dramatic fluctuations in circulation and oxygen levels. The operation was halted, and CO₂ injection was stopped. The surgical wound was covered with saline gauze, and the patient inhaled 100% pure oxygen while undergoing aggressive repeated manual pulmonary recruitment maneuvers. Additionally, vasoactive drugs such as m-hydroxyamine and ephedrine were administered to aid in treating the condition. The patient’s position was adjusted using the Durant maneuver (partial left lateral and Trendelenburg position). Following the aforementioned treatments, the patient’s ventricular arrhythmia transitioned back to a normal and regular sinus rhythm, and both circulation and oxygen levels stabilized.
Conclusions: Carbon dioxide embolism is an uncommon yet potentially severe complication of laparoscopic procedures. We anticipate that this particular case will enhance our comprehension of carbon dioxide embolism during endoscopic surgery.