Gas Embolism during Laparoscopy

Wadhwa, Rajindar K.; McKenzie, Ray; Wadhwa, Saroj R.; Katz, David L.; Byers, James F.

doi:10.1097/00000542-197801000-00011

Cited by 43 publications

(4 citation statements)

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“…46 Blood flow across an opening in an injured vessel may draw gas into the vessel by the venturi effect. 47 In clinically proven cases of venous gas embolism however, evidence of vascular injury is sometimes absent. 48 Consequences of venous gas embolism depend on the rate, the amount and the nature of the gas introduced.…”

Section: Effects Of Tension Pneumoperitoneummentioning

confidence: 99%

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Anaesthesia for Laparoscopic General Surgery

Chui

Gin

1993

Anaesth Intensive Care

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Laparoscopic surgery minimises postoperative morbidity. Patient benefits include reduction in postoperative pain, better cosmetic result and quicker return to normal activities. Hospital stay is shortened resulting in a reduction in overall medical cost. The intraoperative requirements of laparoscopic surgery however can lead to serious physiological changes and complications. While there is a low but definite perioperative mortality rate associated with minor gynaecologic laparoscopic procedures, laparoscopic general surgical procedures are performed on older patients and patients with acute surgical conditions and are likely to be associated with a higher incidence of perioperative complications. The major problems during laparoscopic surgery are related to the cardiopulmonary effects of pneumoperitoneum, systemic carbon dioxide absorption, extra peritoneal gas inSUfflation, venous gas embolism and unintentional injuries to intra-abdominal structures. An appraisal of the potential problems is essential for optimal anaesthetic care of patients undergoing laparoscopic surgery. Appropriate anaesthetic techniques and monitoring facilitate surgery and allow early detection and reduction of complications. The need for rapid recovery and short hospital stay impose additional demands on the anaesthetist for skiltjul practice.

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Section: Effects Of Tension Pneumoperitoneummentioning

confidence: 99%

“…However the routine use of a precordial doppler appears not warranted because of the low incidence of this complication. 47 Airway pressure monitor is mandatory for anaesthetised patients receiving IPPY. Patients undergoing laparoscopic surgery have elevated airway pressure during IPPV.…”

Section: Monitoring Devicesmentioning

confidence: 99%

Anaesthesia for Laparoscopic General Surgery

Chui

Gin

1993

Anaesth Intensive Care

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“…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 ).…”

Section: Surgery Above the Heartmentioning

confidence: 99%

Venous Air Embolism

Borromeo

2010

Surgical Intensive Care Medicine

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DefinitionsGas embolism refers to the abnormal presence of gas within the circulatory system. It is a known complication of various surgical, therapeutic, and diagnostic procedures. It can also occur as a result of trauma. Gas embolism may be asymptomatic or may even result in immediate cardiovascular collapse. The type and severity of sequelae depend on the composition and amount of gas, the rate and location of entry, and on patient characteristics such as size, cardiopulmonary reserve, and presence of an intracardiac rightleft communication. An understanding of the etiologies and pathophysiology of gas embolism is important in order to recognize, treat, and, most importantly, prevent this potentially catastrophic complication.Gas enters the circulation when two conditions co-exist: (1) a communication between a gas source and the vascular system, and (2) a pressure gradient that favors gas entry into the vasculature. When the atmosphere is the source of gas, then this condition is termed air embolism. Gas can be entrained into open veins or venous sinuses, insufflated into traumatized vessels, or accidentally infused under pressure through indwelling venous or arterial catheters. Rarely, dissolved gas is released in blood through effervescence caused by rapid re-warming or decompression. 1 Venous (pulmonary) gas embolism (VGE) refers to gas that gains entry into the venous system and causes morbidity via its effects on the right heart and pulmonary vasculature. Systemic (arterial) gas embolism (SGE) results from gas that is propelled by the left heart and embolizes to systemic arterial beds causing ischemia and infarction. Paradoxical gas embolism (PGE) originates in the venous system and gains access to the arterial system through intracardiac defects or the pulmonary circulation.

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“…Besides potential visceral injury, an unintentional vascular cannulation may result in massive hemorrhage or fatal gas embolism. Venous gas embolism is a rare complication of gaseous pneumoperitoneum, with an incidence of 0.002% to 0.6% in the gynecological patients [13,22,23]. Although CO 2 is the current gas of choice for laparoscopy, partly because of its theoretical low risk of gas embolism, fatal incidents involving this gas have occurred [2,7,16,23].…”

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confidence: 99%