Kyu Nam Kim1, Dong Won Lee2, Ji Yeon Kim1, Kyoung-Hee Han1, Kyung Tae2. 1. Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea. 2. Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Abstract
BACKGROUND: Carbon dioxide (CO2 ) embolism is a serious, although rare, complication of remote access thyroidectomy using CO2 insufflation. Recently, we encountered a case of CO2 embolism during transoral thyroidectomy, and present it here with a review of the literature. METHODS AND RESULTS: A 59-year-old female patient with papillary thyroid carcinoma underwent transoral robotic thyroidectomy with CO2 insufflation. During skin flap elevation, the anterior jugular vein was lacerated. Simultaneously, an electrocardiogram (ECG) showed bradycardia with premature atrial complexes, followed by asystole. After 2 cycles of cardiopulmonary resuscitation with an injection of 1-mg epinephrine, spontaneous circulation returned, and sinus tachycardia with ST segment elevation was noted in ECGs. The patient's vital signs returned to normal within 30 minutes, and normal sinus rhythm was observed. She was discharged on postoperative day 7, without neurologic and cardiac deficit. CONCLUSION: The possibility of CO2 embolism during transoral thyroidectomy with CO2 insufflation should not be overlooked.
BACKGROUND:Carbon dioxide (CO2 ) embolism is a serious, although rare, complication of remote access thyroidectomy using CO2 insufflation. Recently, we encountered a case of CO2embolism during transoral thyroidectomy, and present it here with a review of the literature. METHODS AND RESULTS: A 59-year-old female patient with papillary thyroid carcinoma underwent transoral robotic thyroidectomy with CO2 insufflation. During skin flap elevation, the anterior jugular vein was lacerated. Simultaneously, an electrocardiogram (ECG) showed bradycardia with premature atrial complexes, followed by asystole. After 2 cycles of cardiopulmonary resuscitation with an injection of 1-mgepinephrine, spontaneous circulation returned, and sinus tachycardia with ST segment elevation was noted in ECGs. The patient's vital signs returned to normal within 30 minutes, and normal sinus rhythm was observed. She was discharged on postoperative day 7, without neurologic and cardiac deficit. CONCLUSION: The possibility of CO2embolism during transoral thyroidectomy with CO2 insufflation should not be overlooked.