Last year my ectopic pregnancy was overlooked by my gynecologist, despite only having one tube, and this being somewhat damaged from endometrosis and surgery nearly 20 years ago. Having been tested and found to be pregnant, my HCG levels were NOT rising as they should. Apparently whilst in surgery carbon dioxide was blown into my heart which started to `suck` on air. In recovery I had betadine and a bruise in my neck where they had put a shunt into my neck to suck gas out, which they bent anyway in the process, however the gas by then had expelled. Who was responsible for this `slight complication` as the anesthetist put it. The surgeon or the anesthetist? I have been left wondering what exactly did happen in theatre this day. 

ﾠDuring a laparoscopic surgical procedure carbon dioxide (CO2) is pumped into the belly. This creates space within the abdomen for the surgeon to see the internal organs and to perform the surgery. During this procedure, CO2 is absorbed continually in small amounts into the blood stream, and is safely expired via the lungs, along with body's normal load of CO2 produced by the tissues. At the end of the procedure the remaining gas is expelled from the small incisions in the belly. 

Some patients have shoulder tip pain after such procedures, which is thought to be due to irritation of the diaphragm, but most patients experience no harm at all from the CO2 gas. 

Occasionally however, a large amount of CO2 can enter an internal blood vessel all at once - this is known as an embolism. A large embolism can cause problems with the flow of blood through the heart and lungs. The blood pressure may drop, and circulation to the body is decreased. An air embolism can be a fatal event, but a CO2 embolism, fortunately, does not usually cause much harm because the CO2 is rapidly absorbed into the tissues and exhaled. 

One of the recommended treatments in the case of a severe air embolism is the insertion of a central venous catheter, the tip of which reaches all the way into the right atrium of the heart. From here, air (or CO2) can be sucked out. This may be the event that you are describing. 

My cousin had jaw surgery and because of an air embolism he suffered brain damage? How could this occur? Should they have used equipment to detect the air bubble? 

Thanks for your question. From your brief description, it sounds as though your cousin suffered what is known as an "air embolism" during surgery. This is a fairly well known, though fortunately extremely rare complication of surgery. Air embolism is the passage of air into the circulation. Small air bubbles are usually not a problem, and are easily absorbed without harmful effect unless the individual has abnormal heart anatomy ("hole in the heart") or some other heart or circulatory defect. Large amounts of air can cause serious problems including cardiac arrest and death, by traveling to the large veins leading to the heart, and mechanically blocking the flow of blood through the heart. 

Air embolism as an unexpected complication of dental or jaw surgery has been described in medical journals and in the lay press. During this type of surgery a drill is used together with irrigation of fluid or air to clear away the debris produced by during the surgery and to cool the drill bit and bone. What has happened during these unfortunate events is the inadvertent injection of a mixture of air and water under pressure which then passes into the mandible (jaw) to the veins and then to the large vessels leading to the heart. 

There is no equipment that specifically detects air bubbles. If the jaw surgery were done under general anesthesia the anesthesiologist would be routinely monitoring signs of heart and lung function. If a large air embolism occurred, sufficient to restrict blood flow through the heart, then signs of such impairment would occur. There might be very little warning of trouble, or it might develop more slowly. Changes might include a drop in blood pressure, an increase in heart rate, and a decrease in exhaled carbon dioxide, all of which can be detected with standard equipment. Another sign is the appearance of air under the skin, which is known as subcutaneous emphysema.