Paradoxical carbon dioxide embolism during laparoscopic nephrectomy

Excerpt

A 64-year-old female underwent laparoscopic nephrectomy for a kidney carcinoma. Amid the operation, the end-tidal carbon dioxide dropped from 39 to 22 mmHg. The expected wake at the end of the procedure did not achieve. The magnetic resonance imaging demonstrated diffuse lesions with restricted diffusion localized in the intracerebral parenchyma (Fig. 1). Paradoxical carbon dioxide embolism was diagnosed. No signs of right-to-left shunting were detected by transesophageal echocardiography. The patient was given Rivaroxaban for anticoagulant therapy. The patient remained in a coma 20 days before she recovered. During the hospitalization, the patient developed acute appendicitis and lung infection. After 60 days, the patient was discharged from the hospital, but there were some abnormalities in cognitive function, balance dysfunction, swallowing dysfunction, speech disorder, normal muscle strength of the limbs, and grade 4 muscle strength of the right lower limb.

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