Data consistently show that in experienced trained hands, laparoscopic tubal sterilization is safe and highly effective regardless of the approach or occlusive method. The known mortality rate is between four and eight deaths per 100,000 cases and the rate of intraoperative and postoperative major complications is less than 1%. The anesthetic complication rate for laparoscopy is between 0.016% and 0.75%. Carbon dioxide (CO2) pneumoperitoneum effects are still controversial. Here the authors present a case report of patient who suffered from intraoperative cardiac arrest during laparoscopic tubal ligation under general anesthesia. No definite cause has been identified. The authors outline several possible mechanisms that could have been involved and attempt to discuss these events in the face of published reports describing similar complications.