Carbon dioxide embolism during transanal total mesorectal excision (TaTME): two case reports

Abstract

Transanal total mesorectal excision (TaTME), a new approach for rectal cancers, requires transanal carbon dioxide (CO₂) high-flow insufflation to create a workplace. Two patients scheduled for TaTME experienced CO₂ embolism during the anterior mesorectal dissection in contact with the prostate. CO₂ embolism resulted in a sudden drop of end-tidal CO₂, preceded by a short increase in one patient, and in oxygen desaturation. Hemodynamic alterations were minor. We report these two cases and discuss the pathophysiology of CO₂ embolism and risk factors that promote CO₂ embolism during TaTME to warn anesthetists of this serious complication, often unexpected and misdiagnosed.