Introduction
The introduction of laparoscopy has revolutionized modern surgery. As more procedures are performed with laparoscopic techniques, the use of laparotomy and other open techniques have declined. Patients undergoing these minimally invasive procedures are having shorter lengths of hospital stay, less pain, quicker recovery and, in many instances, the overall cost of the procedure is less1-3. However, the introduction of laparoscopy has brought unique complications. This review article will discuss the rare yet possibly fatal risk of cardiovascular collapse during laparoscopy.
The first laparoscope was performed in the early 20thcentury. Quickly pneumoperitoneum protocols were established to improve intraabdominal visualization. By 1968, the Verres needle was invented and carbon dioxide was used routinely as an insufflation gas. Carbon dioxide has become a mainstay of laparoscopy because it is inexpensive, readily available, non-flammable, colorless and highly soluble in blood. Early laparoscopic techniques were developed in the gynecological realm specifically to cause permanent sterilization. Early laparoscopic gynecologists would insert the Verres needle into the posterior cul-de-sac or even into the cervix and through the uterine fundus to begin insufflation4,5. These techniques encountered some complications and therefore placing the insufflating device through the abdominal wall has become more commonplace.
The combination of blind entry into the abdomen and the exposure of the patient to carbon dioxide gas has created some unique opportunities for cardiovascular collapse to occur during laparoscopic procedures. Estimates of laparoscopic mortality range from 1-4/100,000 cases3,5,6with 50% of all major laparoscopic complications occurring at abdominal entry and insufflation1. There is a 1/2,500 incidence of cardiac arrest during laparoscopy6 with a 14% rate of dysrhythmias3. This review article will briefly review the normal physiological alterations caused by a carbon dioxide pneumoperitoneum and then discuss the leading causes of cardiovascular collapse related to the formation of that pneumoperitoneum. We will then touch upon the differential diagnosis of these causes and immediate management of the patient experiencing cardiovascular collapse.