Published in:
01-05-2013
Air in the insufflation tube may cause fatal embolizations in laparoscopic surgery: an animal study
Published in: Surgical Endoscopy | Issue 5/2013
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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.