Carbon dioxide Embolism

Venous CO₂embolism

End-tidal CO₂ monitoring is essential during laparoscopy, as it may help in the early detection of venous CO₂ embolism (accidental insufflation of CO₂ into the veins). In addition, CO₂ is also absorbed from abdominal cavity. A transient but rapid rise in PETCO₂, has been suggested as a useful early sign of venous CO₂ embolism.

However, when the CO₂ embolism is large enough so as to cause pulmonary outflow obstruction resulting in decreased cardiac output, PETCO₂ decreases thereby increasing the alveolar dead space as well as (a-ET)PCO₂ difference.

Reference:

Shulman D, Aronson HB. Capnography in the early diagnosis of carbon dioxide embolism during laparoscopy. Can Anaesth Soc J 1984;31:455-9.