Experimental carbon dioxide pulmonary embolization after vena cava laceration under pneumoperitoneum

Abstract

The potential for pulmonary embolization following major venous laceration occurring during laparoscopic surgery has never been evaluated. Five anesthetized dogs were hemodynamically monitored with an arterial line and Swan-Ganz catheter. Observation by transesophageal echocardiography (TEE) allowed comparison with pulmonary artery pressure (PAP) recording. Under pneumoperitoneum, a 1-cm venotomy was performed in the infrarenal vena cava and a total of 11 events were evaluated upon unclamping the venotomy. These results were compared with intravenous (i.v.) bolus injections of 15 cc of CO2 (15 events) and of 100 cc of CO2 (12 events). The animals were maintained euvolemic. In 2 out of the 11 (18%) events which followed unclamping the venotomies, a few CO2 bubbles were seen in the right heart cavities. However, the quantity of gas was much less important than that seen after i.v. injection of 15 cc and 100 cc of CO2. There was no significant elevation of the PAP from pre-event values after venotomy or after i.v. injection of 15 cc of CO2. However, there was a significant difference (P < 0.05) when these results were compared to the PAP values recorded after i.v. injection of 100 cc of CO2. No dog died after these episodes of embolization. Massive i.v. injection of CO2 (> 300 cc) led to appearance of gas bubbles in the left heart cavities and death. This experiment suggests that caution should be exerted when laparoscopic surgery is performed beside large veins. Nevertheless, the observation that no gas embolism occurred in 82% of the cases after unclamping venotomies was unexpected. In contrast, many more gas bubbles were detected in the right heart after i.v. injection of only 15 cc of CO2. TEE is a more sensitive indicator of pulmonary embolization than elevation of PAP.

Cardiopulmonary changes during laparoscopy and vessel injury: comparison of CO 2 and helium in an animal model

“…Nevertheless, our results confirm the findings of Bazin and Dion [15,16]. Laparoscopy with either carbon dioxide or helium and an intra-abdominal pressure of 15 mmHg did not cause significant changes in cardiopulmonary functions or obvious gas embolism.…”

“…Dion et al [15] also evaluated the potential for CO 2 embolization from a 1-cm vena cava laceration during laparoscopy at a pressure of 15 mmHg in dogs. Interestingly, they found no changes in cardiac or pulmonary function during this procedure.…”

A Case of Portal Venous Gas Secondary to Acute Appendicitis Detected on Gray Scale Sonography but Not Computed Tomography

“…Although the volume of air bubbles passing through the portal vein seemed large to the eye during real-time sonographic observation, in fact it could have been overestimated by the high sensitivity of sonography in showing up to a few moving air bubbles at a time. 16 Therefore, the volume of PVG observed in our case could have been very small and could have fallen under the spatial resolution of CT, even when differences in density were accentuated after contrast product administration.…”

Venous gas embolism during endoscopy

“…Venous gas embolism is a rare event, occurring as a complication of venous catheter placement, intravenous infusion, autotransfusion, venous trauma, hysteroscopy, pneumoperitoneum, and hyperbaric injury [4,10]. Even in laparoscopic surgery, in which large intra-abdominal vessels may be directly exposed to insufflation gas under pressure, venous gas embolism occurs in fewer than 1 of 7,500 cases [3,18,20,22].…”