# Systemic gas embolism in three cases of CT-guided percutaneous lung puncture under general anesthesia: case reports and literature review

## TL;DR

This paper reports three cases of dangerous gas embolism during lung puncture procedures under anesthesia, highlighting the risks and management strategies.

## Contribution

The study provides clinical insights and actionable strategies for preventing and managing gas embolism during CT-guided lung punctures under general anesthesia.

## Key findings

- Gas embolism can lead to cardiac arrest during CT-guided lung puncture under general anesthesia.
- Prompt intervention, including CPR and thoracoscopic surgery, can lead to full recovery from gas embolism.
- Hybrid operating rooms under general anesthesia may mask early signs of air embolism, increasing risks.

## Abstract

CT-guided percutaneous lung puncture is a minimally invasive technique widely used for localizing pulmonary nodules prior to resection. While rare, systemic gas embolism represents a potentially catastrophic complication. This case series analyzes three patients undergoing general anesthesia for small lung lesion resection after CT-guided localization, aiming to improve their perioperative recognition and intervention.

Case 1 experienced intraoperative cardiac arrest due to gas embolism but recovered fully after prompt cardiopulmonary resuscitation (CPR) and delayed thoracoscopic surgery. Case 2 developed postoperative hemiplegia and dysarthria due to delayed intervention, with partial neurological recovery after one month. Case 3 received immediate treatment, resulting in stable vital signs and no sequelae.

These cases illustrate that CT-guided percutaneous lung puncture under general anesthesia carries both benefits and risks. Gas embolism may occur during the biopsy procedure, and if not promptly detected under general anesthesia, it could potentially lead to cardiac arrest. Hybrid operating rooms general anesthesia helps streamline workflow but may mask early signs of air embolism and pose specific risks. Key prevention and management strategies are extremely important, including routine single-lung isolation with the use of a double-lumen endotracheal tube or bronchial blocker, keeping the operated lung at low continuous positive airway pressure (CPAP) during puncture with minimal needle passage, and CT surveillance immediately after surgery. Multidisciplinary coordination, vigilant monitoring, and prompt intervention, including repositioning of the patient and administration of 100% oxygen, are essential to mitigate serious outcomes.