Cerebral gas embolism in a patient without right-to-left shunt after robotic partial nephrectomy.

IF 0.8 Q3 ANESTHESIOLOGY

JA Clinical Reports Pub Date : 2025-05-24 DOI:10.1186/s40981-025-00793-w

Mori Satori, Mitsuhiro Matsuo, Yoshinori Ikehata, Hiroshi Kitamura, Tomonori Takazawa

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Abstract

Background: Cerebral gas embolism is a rare but serious complication of laparoscopic surgeries, the risk of which is increased by the presence of right-to-left shunt. A case of cerebral gas embolism after robotic partial nephrectomy is presented.

Case presentation: A 71-year-old man underwent robotic partial nephrectomy. During tumor resection, end-tidal CO₂ (ETCO₂) decreased from 42 to 34 mmHg, followed by a decrease in mean arterial pressure (MAP) to < 65 mmHg and oxygen saturation (SpO₂) to 95%. Postoperatively, he exhibited delayed emergence from anesthesia and left conjugate gaze deviation. Neuroimaging revealed cerebral gas embolism. A bubble test performed by a cardiologist under positive pressure ventilation ruled out right-to-left shunt. Despite postoperative treatment, the patient became bedridden with severe neurological sequelae.

Conclusions: Cerebral gas embolism can occur during robotic procedures even without right-to-left shunt. Anesthesiologists must promptly recognize intraoperative signs of this complication and initiate timely interventions to prevent severe complications.

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机械人肾部分切除术后无左-右分流术患者的脑气栓塞。

背景：脑气栓塞是腹腔镜手术中一种罕见但严重的并发症，其风险因右至左分流的存在而增加。报告一例机器人肾部分切除术后脑气栓塞的病例。病例介绍：一位71岁的男性接受了机器人肾部分切除术。在肿瘤切除期间，潮末CO₂（ETCO₂）从42下降到34 mmHg，随后平均动脉压（MAP）下降。结论：即使没有右至左分流，机器人手术也可能发生脑气栓塞。麻醉医师必须及时识别术中该并发症的体征，并及时采取干预措施，防止严重并发症的发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.