Clinically Significant Gas Embolus - APSA Practice Gaps 2019

So, same thing, um, basically you have a baby that you're starting your lap pyloromyotomy on, and all of a sudden the entitle CO2 has become non-detectable. And the child has a cardiac arrest. So, the question that we pose is what is the most likely cause of this arrest during laparoscopy? Gas embolus, unrecognized hemorrhage to the trocar site, pneumopericardium from extraperitoneal insufflation, monitor error, and inadvertent endotracheal extubation. Yeah, your presen- your question was much better than Max's. I agree. But now everyone knows the answer, knows the answer. So, we've made- I did give the answer. We've made glorious progress, right? Actually, actually the most- this is a cool test. the most likely cause is E. Yeah. Because this happened the gas embalism doesn't happen very very much. I I think that's correct. But hopefully you will have the wherewithal to have gas embolis at the top of your mind. on your mind. Yes, and not you know it's very convenient to blame everything on anesthesia. We all love doing it, right? It's rare but the mortality is high. Um, one of the things that's that's actually interesting is that it's nitrogen and the air embalism that causes the most problems with hemodynamics. So, one trick that you can do is, you know that the insufflation tubing has a large amount of air in it, probably 40 mils. If you run the CO2 through the tubing, and you before you hook the tubing up, then you'll minimize the amount of nitrogen that you actually put in. That's interesting. the baby. So there are some there are some people that think if you run the CO2 through the tubing that you'll decrease the risk of really having a significant gas embolus. Wow. Didn't know that. All right, that will be a change. I have not done that before. Um, management again, take out the cannula, deflate the abdomen, put the baby in Trendelenburg, um, inotropes, chest compression. Um, some people talk about aspirating the gas through a central Venus catheter and um, obviously ECMO or hyperbaric oxygen. That's a great slide because the these things are not things you could look up. You kind of just have to hope you remember what you just showed. Uh, Well it's it's very, you know when we were in training for general surgery, we were all taught how to deal with an air embalism, right? Air embalism. Never heard of it. Right. And and I don't think maybe any of us ever saw it, but we were all it was, you know, bammed into our heads of the things that you had to do if it happened. Yeah. And so I think that's probably where these dictum come from or these ideas come from. That was awesome, actually. That worked out. All right.