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

Abstract

Abstract 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.

Keywords

• Carbon dioxide
• Case report
• Gas embolism
• Paradoxical embolism
• Nephrectomy