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.