Haemodynamic conditions enhancing gas embolism after venous injury during laparoscopy: a study in pigs

Abstract

This study was designed to determine the conditions that promote carbon dioxide embolism after venous injury during laparoscopy in pigs. Injury to an iliac vein was filmed during laparoscopy in the presence of a pneumoperitoneum created at increasing pressures from 0 to 30 mm Hg in 5-mm Hg increments. At intraperitoneal pressures less than 20 mm Hg, there was a parallel increase in femoral venous pressures, resulting in haemorrhage, with persistent blood flow to the inferior vena cava. At intraperitoneal pressures of 20-30 mm Hg, there was collapse of the femoral vein, occurring earlier in the presence of hypovolaemia. Between these two states (haemorrhage and collapse), there was a point of equilibrium which allowed retrograde venous penetration of carbon dioxide bubbles. During release of the pneumoperitoneum, these bubbles were exteriorized through the area of the injury, but some passed into the inferior vena cava where their presence was detected by an oesophageal Doppler probe.

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.…”

“…Unfortunately, helium was not investigated in this experiment. Bazin et al [16] demonstrated that injury of the iliac vein during laparoscopy with CO 2 caused no intravenous gas penetration at intraperitoneal pressures lower than 20 mmHg, while higher pressures led to detectable gas bubbles in the iliac vein. Thus, vessel injury during laparoscopy and elevated intraperitoneal pressure of 15 mmHg does not automatically cause venous gas embolism.…”

Fatal central venous air embolism: A rare complication of esophageal dilation by rendezvous

“…Continuous addition of insufflated air is hypothesized to create conditions favorable for venous air embolism by increasing intraluminal pressure. 20,22,24 Interestingly, the use of specific gas types during endoscopy or laparoscopy has been the subject of debate. 22 Currently, almost all laparoscopy is performed using carbon dioxide due to its properties as a noncombustible, commonly available gas with high aqueous solubility.…”

Venous gas embolism during endoscopy

“…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]. Gas embolism during endoscopy is an even rarer event.…”