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The effects of experimental venous carbon dioxide embolization on hemodynamic and respiratory variables
Karolinska institutet.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Karolinska institutet.
2006 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 2, 156-162 p.Article in journal (Refereed) Published
Abstract [en]

Background:  Laparoscopic liver resection is a relatively new surgical procedure. Carbon dioxide (CO2) pneumoperitoneum and laparoscopic liver dissection are recognized as risk factors for CO2 embolism to the pulmonary circulation. The embolization can be difficult to detect and can theoretically increase peri-operative morbidity. The aim of this study was to evaluate the cardiopulmonary effects in a pig model during a time period of 4 h after an experimental CO2 embolization.

Methods:  Eleven piglets were anesthesized. Nine were embolized with a single intravenous injection of 0.4 ml/kg CO2 and two served as controls. Respiratory and cardiovascular variables, including pulmonary artery pressure and cardiac output, were monitored for 4 h after embolization, and arterial blood gases were monitored on-line.

Results:  The embolized piglets had an increase in ventilatory dead space, pulmonary vascular resistance and pulmonary artery pressure and a decrease in cardiac output that lasted throughout the 4-h observation time. The mean arterial pressure and heart rate were unchanged. An early sign of embolization was a rapid fall in end-tidal CO2 and Pao2 and a rise in Paco2.

Conclusion:  Negative changes in cardiopulmonary physiology persisted for at least 4 h after a single intravenous CO2 injection, in spite of this gas being highly soluble in blood. This is a more prolonged influence of CO2 embolization than previously described. Extensive monitoring for early detection of an embolization may be recommended to limit morbidity in patients undergoing laparoscopic liver surgery.

Place, publisher, year, edition, pages
2006. Vol. 50, no 2, 156-162 p.
Keyword [en]
carbon dioxide embolism, cardiopulmonary physiology, laparoscopic liver surgery
National Category
Clinical Medicine
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-75720DOI: 10.1111/j.1399-6576.2006.00933.xPubMedID: 16430535OAI: oai:DiVA.org:uu-75720DiVA: diva2:103631
Available from: 2006-02-15 Created: 2006-02-15 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Gas Embolism in Laparoscopic Liver Surgery
Open this publication in new window or tab >>Gas Embolism in Laparoscopic Liver Surgery
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Laparoscopic liver surgery is complicated due to the structure of this organ with open sinusoids. A serious disadvantage is the risk of gas embolism (GE) due to CO2 pneumoperitoneum. CO2 can enter the vascular system through a wounded vein. A common opinion is that gas fluxes along a pressure gradient, e.g. CVP-intra abdominal pressure (IAP). The occurrence of GE could also be eased by entrainment, a ‘Venturi-like’ effect, due to cyclic differences in thoracic pressure and blood flow caused by mechanical ventilation at normal frequency.

The aims of these studies were to survey, in a porcine model, the influence on respiratory and haemodynamic variables by GE, to determine at what frequency, severity and duration GE occurs during laparoscopic liver resection (LLR) and whether there are methods to influence the occurrence or severity of GE.

Pulmonary and circulatory variables were monitored and measured as well as continuous blood gas monitoring. Transoesophageal echocardiogram was used to identify GE and, according to the amount of bubbles in the right outflow tract of the heart, GE was graded as 0, 1 and 2. Pneumoperitoneum was created by using CO2and IAP was set to 16 mm Hg.

A single bolus dose of CO2 influenced respiratory and haemodynamic variables for at least 4 h. During LLR GE occurred in 65-70% of the animals, of which the more serious caused negative influence on cardiopulmonary variables.

Elevated PEEP (15 cm H2O) increased CVP but GE occurred irrespective if CVP was lower than or exceeded IAP. In two last studies, a hepatic vein was cut and left open for 3 m before it was clipped. Interestingly, no signs of GE were seen despite an open vein and IAP > CVP in 8 of 20 animals. In the last study high frequency jet ventilation was used in order to minimise the risk of entrainment. The duration of GE was shortened.

The occurrence of GE seemed to be influenced by several different factors. The physiological reaction of a GE is impossible to predict for a specific patient, and depends among other factors on comorbidity, and amount, site and entrance rate of GE.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 49 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 758
Keyword
Gas embolism, laparoscopic liver, CVP, PEEP, high frequency jet ventilation, cardiopulmonary physiology, carbon dioxide
National Category
Basic Medicine
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-171797 (URN)978-91-554-8325-8 (ISBN)
Public defence
2012-05-11, Enghoffsalen, Akademiska Sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2012-04-20 Created: 2012-03-27 Last updated: 2012-08-01Bibliographically approved

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Fors, DiddiRubertsson, StenArvidsson, Dag

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