Cardiopulmonary responses to experimental venous carbon dioxide embolism

Abstract

The low-flow insufflation rate exceeds the fatal rate of continuous intravenous CO2 infusion. End-tidal CO2 levels were increased in venous CO2 embolism, not decreased as seen in venous air embolism. Severe hypoxemia and hypotension are predictors of potentially fatal cases.

Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation

“…It has not been reported in digestive endoscopic procedures including ESD, but has mainly been reported in laparoscopic procedures [36]. Because of its high solubility in blood, entry of a large amount of CO 2 into the circulation in a short time might be essential for CO 2 embolism [37,38]. In any case, CO 2 embolism is a very rare complication, and a large number of patients would be required to detect a possible difference in its incidence between the two groups.…”

Massive Carbon Dioxide Embolism During Pneumoperitoneum for Laparoscopic Adrenalectomy: A Case Report

“…Mayer, et al described a mortality of 60% at a continuous intravenous CO 2 infusion rate of 1.2 mL/kg/min, which is equivalent to a rate of 72 mL/min for a 60 kg person. That volume is only 5% of the volume of carbon dioxide that may be infused into a vein, intentionally cannulated by a Veres needle, in one minute at a low-flow rate [9]. Our effort to keep the balance of IVC venous pressure and surrounding CO 2 insufflation pressure during the episode may prevent a massive fetal CO 2 embolism and a fetal bleeding rate.…”

Venous Air Embolism

“…As such, with the patient breathing room air, CO 2 emboli (high partial pressure gradient) decrease in size more rapidly than air emboli (no partial pressure gradient) 62 In dogs, the lethal dose of intravenous CO 2 is at least five times greater than the lethal dose of air. 61 Despite these advantages, episodes of massive CO 2 embolism have been fatal. 28 , 63 The solubilities of other gases implicated in SGE are as follows: argon 0.029 ml/ml blood; nitrogen (the predominant gas in air) 0.014 ml/ml blood 58 ; and oxygen 0.003 ml/ml blood (at normal P A O 2 ).…”

“…Air bubbles at the alveolarcapillary interface serve as a barrier to gas exchange, 61 decreasing the pulmonary diffusing capacity. Additionally, marked ventilation-perfusion (V/Q) mismatch has been demonstrated by multiple inert gas elimination techniques in animals during slow VAE.…”