<prompt> A mill-wheel type of murmur during laparoscopy suggestsTension pneumothoraxintra-abdominal bleedingGas embolismpre-existing valvular disease  <response>: The water-wheel or mill-wheel murmur is classically associated with large intracardiac air emboli and described as a characteristic splashing auscultatory sound due to the presence of gas in the cardiac chambers. . Most venous air gas emboli are iatrogenic . Ref Davidson edition23rd pg 620 