Benign gynaecology: gas embolism at laparoscopy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Benign gynaecology: gas embolism at laparoscopy

Sample item

During laparoscopy with carbon dioxide insufflation, the anaesthetist reports a sudden fall in end-tidal CO2, hypotension and a mill-wheel murmur. What is the immediate action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Stop insufflation, release the pneumoperitoneum and place the patient in left lateral head-down position

A fall in end-tidal CO2 with hypotension and a mill-wheel murmur suggests gas embolism. Insufflation is stopped, the abdomen is deflated, and the patient is placed head down on the left side (Durant position) so that gas collects in the right ventricular apex. Oxygen is given and the gas may be aspirated through a central line.

Option by option

  • A. Place the patient in reverse Trendelenburg position

    Head-up positioning does not trap the gas and can worsen cerebral embolisation.

  • B. Continue surgery and give a fluid bolus only

    Continuing surgery ignores the source of collapse.

  • C. Increase the insufflation pressure to tamponade the vessel

    More insufflation forces more gas into the circulation.

  • D. Stop insufflation, release the pneumoperitoneum and place the patient in left lateral head-down position (correct)

    Correct. Remove the source and position to trap gas away from the outflow tract.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Stop insufflation, release the pneumoperitoneum and place the patient in left lateral head-down position. A fall in end-tidal CO2 with hypotension and a mill-wheel murmur suggests gas embolism.

Why is "Place the patient in reverse Trendelenburg position" not the answer?

Head-up positioning does not trap the gas and can worsen cerebral embolisation.

Why is "Continue surgery and give a fluid bolus only" not the answer?

Continuing surgery ignores the source of collapse.

Why is "Increase the insufflation pressure to tamponade the vessel" not the answer?

More insufflation forces more gas into the circulation.

What concept does this question test?

It tests Benign gynaecology: gas embolism at laparoscopy in OBG. Insufflation is stopped, the abdomen is deflated, and the patient is placed head down on the left side (Durant position) so that gas collects in the right ventricular apex. Oxygen is given and the gas may be aspirated through a central line.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Benign gynaecology: gas embolism at laparoscopy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.