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Venous Air Embolism Management — FRCA Final MCQ

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HardAnaesthetic Equipment & SafetyVenous Air Embolism ManagementFRCA Final

A 50-year-old man undergoing laparoscopic cholecystectomy develops a massive venous carbon dioxide embolism after the Veress needle enters a large hepatic vein during insufflation. End-tidal carbon dioxide falls abruptly and severe hypotension develops, although a central pulse remains palpable. Insufflation has been stopped, the pneumoperitoneum released, the venous injury controlled, and ventilation with an inspired oxygen fraction of 1.0 and circulatory support have begun. He has been placed in the left lateral position. A multiorifice central venous catheter with its tip at the cavoatrial junction was inserted before surgery. Which additional intervention is most appropriate now?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Attempt gas aspiration through the existing central venous catheter

The correct answer is D. Once gas entry has been stopped and immediate oxygenation and circulatory support instituted, gas aspiration should be attempted through a suitably positioned central venous catheter that is already in situ. This may relieve a right-sided intracardiac gas lock; catheter insertion solely for aspiration should not delay resuscitation. Conversion to laparotomy is not automatically required once the source and venous injury are controlled. Hyperbaric oxygen is not the next intervention during unresolved intraoperative cardiovascular collapse and is principally considered when systemic arterial or neurological gas embolism is suspected. Heparin does not treat gas embolism. Chest compressions can help disperse gas and must be started if cardiac arrest occurs, but they are inappropriate while an effective central pulse remains.

Reference: Association of Anaesthetists (AAGBI), Quick Reference Handbook: Guidelines for crises in anaesthesia, section 3-5 'Circulatory embolus', v1 2018; RCoA-hosted edition. https://rcoa.ac.uk/media/9386