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Background <p>Cerebral gas embolism is a rare but serious complication of laparoscopic surgeries, the risk of which is increased by the presence of right-to-left shunt. A case of cerebral gas embolism after robotic partial nephrectomy is presented.</p> Case presentation <p>A 71-year-old man underwent robotic partial nephrectomy. During tumor resection, end-tidal CO₂ (ETCO₂) decreased from 42 to 34&#xa0;mmHg, followed by a decrease in mean arterial pressure (MAP) to &lt;&#xa0;65&#xa0;mmHg and oxygen saturation (SpO₂) to 95%. Postoperatively, he exhibited delayed emergence from anesthesia and left conjugate gaze deviation. Neuroimaging revealed cerebral gas embolism. A bubble test performed by a cardiologist under positive pressure ventilation ruled out right-to-left shunt. Despite postoperative treatment, the patient became bedridden with severe neurological sequelae.</p> Conclusions <p>Cerebral gas embolism can occur during robotic procedures even without right-to-left shunt. Anesthesiologists must promptly recognize intraoperative signs of this complication and initiate timely interventions to prevent severe complications.</p>

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Cerebral gas embolism in a patient without right-to-left shunt after robotic partial nephrectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月24日

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  • Mori Satori,
  • Mitsuhiro Matsuo,
  • Yoshinori Ikehata,
  • Hiroshi Kitamura,
  • Tomonori Takazawa

摘要

Background

Cerebral gas embolism is a rare but serious complication of laparoscopic surgeries, the risk of which is increased by the presence of right-to-left shunt. A case of cerebral gas embolism after robotic partial nephrectomy is presented.

Case presentation

A 71-year-old man underwent robotic partial nephrectomy. During tumor resection, end-tidal CO₂ (ETCO₂) decreased from 42 to 34 mmHg, followed by a decrease in mean arterial pressure (MAP) to < 65 mmHg and oxygen saturation (SpO₂) to 95%. Postoperatively, he exhibited delayed emergence from anesthesia and left conjugate gaze deviation. Neuroimaging revealed cerebral gas embolism. A bubble test performed by a cardiologist under positive pressure ventilation ruled out right-to-left shunt. Despite postoperative treatment, the patient became bedridden with severe neurological sequelae.

Conclusions

Cerebral gas embolism can occur during robotic procedures even without right-to-left shunt. Anesthesiologists must promptly recognize intraoperative signs of this complication and initiate timely interventions to prevent severe complications.