Anesthesia Management of Venous Gas Embolism with Hepatectomy

Abstract

Abstract

Background: This is a case review of the intraoperative management of a 46 year old male patient with a history of stage IV sigmoid colon adenocarcinoma with metastasis to the liver that presented for a robotic assisted sigmoidectomy and partial hepatectomy and had an intraoperative venous gas embolism that resulted in acute hemodynamic instability.

Description of the case: A robotic assisted sigmoidectomy and partial hepatectomy was performed on a 46 year old male patient with a history of stage IV sigmoid colon adenocarcinoma with metastasis to the liver.  The patient was otherwise healthy with no other significant medical history, and the perioperative lab results were within normal ranges with the exception of elevated liver function test results.  The patient received preoperative medications for multimodal pain management as part of the enhanced recovery after surgery (ERAS) protocol and had an uneventful induction with intravenous anesthetic induction and endotracheal intubation.  During the intraoperative course, the patient exhibited an acute hypotensive episode followed by acute desaturation. A venous gas embolism was suspected, and immediate interventions were implemented which helped the patient stabilize.  The patient remained hemodynamically stable throughout the remainder of the case.  After surgery, the patient was admitted to the intensive care unit for postoperative monitoring for any neurological or cardiovascular effects related to the intraoperative venous gas embolism.  The postoperative period was uneventful, and the patient was successfully discharged home several days later without any adverse sequelae.

Discussion and conclusions: Venous gas embolism can be a life-threatening intraoperative event that requires fast recognition of the symptoms and appropriate interventions in response to the patient changes.  Evidence suggests that venous gas embolisms are very common with certain procedures but often subclinical.  Preventative measures, early recognition, and prompt treatment of venous gas embolisms are important interventions to minimize the risk for any significant hemodynamic instability and any resulting neurological or cardiovascular sequelae.