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To report life-threatening hemodynamic instability caused by a sudden increase in end-tidal carbon dioxide during thoraco-laparoscopic esophagectomy.

Severe hypercapnia and hemodynamic instability following a sudden elevation in end-tidal CO₂ during thoraco-laparoscopic esophagectomy: a case report and literature review

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To report life-threatening hemodynamic instability caused by a sudden increase in end-tidal carbon dioxide during thoraco-laparoscopic esophagectomy.
Case report of a 61-year-old male undergoing elective thoraco-laparoscopic esophagectomy.
Continuous intraoperative monitoring of end-tidal CO₂ was performed to detect sudden elevations.
Surgical exploration was conducted to address trocar-related lung injury and extensive pleural adhesions.
Abrupt rise in end-tidal carbon dioxide to 213 mm Hg was recorded during the procedure.
Severe hemodynamic instability observed included hypertensive crisis, tachycardia, and progressive bradycardia.
Prompt surgical intervention resulted in stabilization of ventilation and hemodynamic parameters, allowing the procedure to continue successfully.

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Case report highlights hypercapnia and hemodynamic instability in a patient with pleural adhesions, suggesting improved monitoring strategies.

Xu et al. (2026) studied this question.

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Case report highlights hypercapnia and hemodynamic instability in a patient with pleural adhesions, suggesting improved monitoring strategies.