ロボット支援腎部分切除術後に奇異性ガス塞栓による遅発性の神経障害を呈した1症例

Paradoxical Gas Embolism during a Robotic-assisted Partial Nephrectomy followed by Delayed Neurological Deficits

要旨

　56歳，男性，ロボット支援腎部分切除術中にSpo₂，Etco₂の低下と心電図でST変化を呈した。経胸壁心エコー検査で両心室内の気泡像を確認し，奇異性ガス塞栓と診断した。術翌日以降に皮質盲，痙攣，意識障害を発症したが，自然軽快した。マイクロバブルを用いた経胸壁心エコー検査により卵円孔開存を確認した。

　We present the case of a patient who developed a paradoxical gas embolism during a robotic-assisted partial nephrectomy, resulting in delayed neurological deficits. After the incision of the renal cortex, the patient, a 56-year-old Japanese male, experienced a sudden decline in Spo₂ and Etco₂ accompanied by ST changes on electrocardiography. Based on the findings revealed by transthoracic echocardiography（TTE）, we diagnosed a paradoxical gas embolism. The patient exhibited cortical blindness, seizures, and loss of consciousness after the surgery. A patent foramen ovale was confirmed by TTE with microbubbles. Anesthesiologists should be attentive to the possibility of a paradoxical gas embolism and subsequent delayed neurological symptoms in patients undergoing laparoscopic surgeries.