Case Report
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World J Anesthesiol. Nov 27, 2013; 2(3): 26-29
Published online Nov 27, 2013. doi: 10.5313/wja.v2.i3.26
Suspected cerebral arterial gas embolism during a laparoscopic Nissen fundoplication
Gaurav V Kulkarni, P Marco Fisichella, Barbara G Jericho
Gaurav V Kulkarni, P Marco Fisichella, Department of Surgery, Loyola University Medical Center and Hines Jr. VA Medical Center, Maywood, IL 60153, United States
Barbara G Jericho, Department of Anesthesiology, the University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, United States
Author contributions: Kulkarni GV and Fisichella PM helped write the manuscript, participated in patient care, and approved the final manuscript; Jericho BG helped write the manuscript, critically reviewed the manuscript, and approved the final manuscript.
Correspondence to: Barbara G Jericho, MD, Department of Anesthesiology, the University of Illinois Hospital and Health Sciences System, 1740 W. Taylor Street, Room 3200, Chicago, IL 60612, United States. jericho@uic.edu
Telephone: +1-312-9964020 Fax: +1-312-9964019
Received: April 29, 2013
Revised: June 10, 2013
Accepted: July 4, 2013
Published online: November 27, 2013
Processing time: 87 Days and 14.4 Hours
Abstract

We present the first case report known to us of a suspected cerebral arterial gas embolism (CAGE) leading to transient left-sided hemiparesis after a laparoscopic Nissen fundoplication. During the operation there was no evidence of hemodynamic compromise and the end-tidal carbon dioxide level and oxygen saturation had been within normal limits. Radiological studies and transesophageal echocardiography showed no abnormalities. We conclude that CAGE can occur during uncomplicated laparoscopic surgery even in the absence of demonstrable intracardiac shunts.

Keywords: Paradoxical gas embolism; Arterial embolism; Laparoscopic Nissen fundoplication; Neurologic deficit; Laparoscopic surgery

Core tip: We present the first case report known to us of a suspected cerebral arterial gas embolism (CAGE) leading to transient left-sided hemiparesis after a laparoscopic Nissen fundoplication. During the operation there was no evidence of hemodynamic compromise and the end-tidal carbon dioxide level and oxygen saturation had been within normal limits. Radiological studies and transesophageal echocardiography showed no abnormalities. We conclude that CAGE can occur during uncomplicated laparoscopic surgery even in the absence of demonstrable intracardiac shunts.