Clinically Significant Gas Embolus - APSA Practice Gaps 2019

Gas embolism during laparoscopy is rare but has high mortality.

Nitrogen and air embolism cause the most problems with hemodynamics compared to CO2 embolism.

Insufflation tubing contains a large amount of air, probably 40 mL.

Running CO2 through the insufflation tubing before connecting it to the patient can minimize the amount of nitrogen introduced.

Management of gas embolism includes removing the cannula, deflating the abdomen, placing the patient in Trendelenburg position, administering inotropes, and performing chest compressions.

ECMO or hyperbaric oxygen are treatment options for gas embolism.

In general surgery training, management of air embolism was emphasized despite most trainees never seeing a case.