Abstract
Background
The aim of this study was to evaluate the risk of an air embolization with the volume of the insufflation tube during induction of laparoscopy. A further objective was to determine the LD50 of air in young piglets.
Methods
End-tidal carbon dioxide pressure (\( P_{{{\text{CO}}_{2} ,{\text{et}}}} \)), pulmonary arterial pressure (P pa), heart rate (f c), and mean arterial pressure (P a carot) were measured in 17 piglets divided into three groups: group 1 (n = 6), bolus application (CO2 embolization, followed by air embolization, 2 mL/kg each), group 2 (n = 7), continuous air embolization (30 min, 0.2 mL/kg/min), and group 3 (n = 4), continuous CO2 embolization (30 min, 0.4 mL/kg/min).
Results
All animals survived CO2 embolism. Air embolization as a bolus (2 mL/kg) or with an accumulated volume of 3.1 mL/kg led to death. Decreases in \( P_{{{\text{CO}}_{2} ,{\text{et}}}} \) indicated air or massive CO2 embolization only. There was a good correlation between \( P_{{{\text{CO}}_{2} ,{\text{et}}}} \) and P pa in case of air embolization (r = −0.80, p < 0.0001). In contrast, no dependency was recognized during CO2 embolism (r = −0.17, p = 0.2).
Conclusions
In order to minimize the lethal risk of gas embolization, the insufflation system has to be completely filled with CO2 before connecting to the patient.
Similar content being viewed by others
References
Weathersby PK, Homer LD (1980) Solubility of inert gases in biological fluids and tissues: a review. Undersea Biomed Res 7(4):277–296
Roderic G, Longnecker E, Longnecker DE (1992) The therapeutic gases. In: Goodmann-Gilman A, Rall TW, Nies AS, Taylor P (eds) The pharmacological basis of therapeutics. McGraw-Hill, Singapore, pp 332–344
Jayaraman S, Khakhar A, Yang H, Bainbridge D, Quan D (2009) The association between central venous pressure, pneumoperitoneum, and venous carbon dioxide embolism in laparoscopic hepatectomy. Surg Endosc 23:2369–2373
Bazin JE, Gillart T, Rasson P, Conio N, Aigouy L, Schoeffler P (1997) Haemodynamic conditions enhancing gas embolism after venous injury during laparoscopy: a study in pigs. Br J Anaesth 78:570–575
Kim CS, Kim JY, Kwon JY, Choi SH, Na S, An J, Kj Kim (2009) Venous air embolism during total laparoscopic hysterectomy. Anesthesiology 111:50–54
Derouin M, Couture P, Boudreault D, Girard D, Gravel D (1996) Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy. Anesth Analg 82:119–124
Schramm P, Engelhard K, Scherhag A, Schier F, Werner C (2010) High-intensity transient signals during laparoscopic surgery in children. Br J Anaesth 104:224–227
Taylor S, Hoffman GM (2010) Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant. Can J Anesth 57:774–778
Mattei P, Tyler D (2007) Carbon dioxide embolism during laparoscopic cholecystectomy due to a patent paraumbilical vein. J Pediatr Surg 42:570–572
Schmandra TC, Mierdl S, Bauer H, Gutt C, Hanisch E (2002) Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum. Br J Surg 89:870–876
Graff TD, Arbegast NR, Phillips OC, Harris LC, Frazier TM, Baltimore SM (1959) Gas embolism: a comparative study of air and carbon dioxide as embolic agents in the systemic venous system. Am J Obstet Gynecol 78:259–265
Liu FC, Tsao CM, Lui PW (2001) Hemodynamic changes caused by venous gas embolism in dogs: comparisons among air, carbon dioxide and oxygen. Acta Anaesthesiol Sin 39:71–76
Yau P, Watson D, Lafullarde T, Jamieson GG (2000) Experimental study of effect of embolism of different laparoscopy insufflation gases. J Laparoendosc Adv Surg Tech 10:211–216
Giebler R, Kollenberg B, Pohlen G, Peters J (1998) Effect of positive end-expiratory pressure on the incidence of venous air embolism and on the cardiovascular response to the sitting position during neurosurgery. Br J Anaesth 80:30–35
Marshall WK, Bedford RF (1980) Use of a pulmonary-artery catheter for detection and treatment of venous air embolism: a prospective study in man. Anesthesiology 52:131–134
Svenarud P, Persson M, van der Linden J (2004) Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial. Circulation 109:1127–1132
Rendas A, Branthwaite M, Reid L (1978) Growth of pulmonary circulation in normal pig—structural analysis and cardiopulmonary function. J Appl Physiol 45:806–817
Hashizume M, Sugimachi K (1997) Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc 11:1198–1201
Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomie: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165:9–14
Ribeiro A, Lindmarker P, Johnsson H, Juhlin-Dannfelt A, Jorfeldt L (1999) Pulmonary embolism: one-year follow-up with echocardiography Doppler and five-year survival analysis. Circulation 99:1325–1330
Albertine KH, Wiener-Kronish JP, Koike K, Staub NC (1984) Quantification of damage by air emboli to lung microvessels in anesthesized sheep. J Appl Physiol 57(5):1360–1368
Martens S, Dietrich M, Doss M, Deschka M, Keller H, Moritz A (2006) Behavior of gaseous microemboli in extracorporeal circuits: air versus CO2. Int J Artif Organs 29:578–582
Couture P, Boudreault D, Derouin M, Allard M, Lepage Y, Girard D, Blaise G (1994) Venous carbon dioxide embolism in pigs: an evaluation end-tidal carbon dioxide, transesophageal echocardiography, pulmonary artery pressure, and precordial auscultation as monitoring modalities. Anesth Analg 79:867–873
Jersenius U, Fors D, Rubertsson S, Arvidsson D (2006) The effects of experimental venous carbon dioxide embolization on hemodynamic and respiratory variables. Acta Anaesthiol Scand 50:156–162
Wiegand UKH, Kurowski V, Giannitsis E, Katus HA, Djonlagic H (2000) Effectiveness of end-tidal carbon dioxide tension for monitoring of thrombolytic therapy in acute pulmonary embolism. Crit Care Med 28:3588–3592
Disclosures
Drs. Steffen Richter, Christine Matthes, Till Ploenes, Devrim Aksakal, Tobias Wowra, Thomas Hückstädt, Felix Schier, and Christoph Kampmann have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
The first two authors contributed equally to this work, and both should be considered first author.
Rights and permissions
About this article
Cite this article
Richter, S., Matthes, C., Ploenes, T. et al. Air in the insufflation tube may cause fatal embolizations in laparoscopic surgery: an animal study. Surg Endosc 27, 1791–1797 (2013). https://doi.org/10.1007/s00464-012-2651-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2651-3