CO2 Gas Embolism Laparoscopy — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardAnaesthetic Equipment & SafetyCO2 Gas Embolism LaparoscopyFRCA Final

A 45-year-old man (ASA II) is undergoing laparoscopic cholecystectomy. After insufflation to 15 mmHg, the ETCO2 suddenly drops to zero and the patient becomes profoundly hypotensive with distended neck veins. SpO2 falls rapidly. What is the most likely diagnosis?

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

Reveal the answer and explanation

Correct answer: B — Carbon dioxide gas embolism

Sudden loss of ETCO2, cardiovascular collapse, and distended neck veins during laparoscopic insufflation is pathognomonic of massive CO2 gas embolism. CO2 enters the venous system through an inadvertently cannulated vessel or through the hepatic venous plexus. Large volumes of gas cause an air-lock in the right ventricle, obstructing pulmonary outflow. Management: stop insufflation and deflate pneumoperitoneum, left lateral head-down (Durant's) position, 100% O2, attempt aspiration via central line, CPR if needed. Precordial Doppler may detect earlier smaller emboli.

Reference: RCOA – 2023 – Laparoscopic surgery complications; AAGBI – 2020 – Laparoscopic safety