Reducing the risk of systemic embolization during gynecologic laparoscopy − effect of volume preload

Tuppurainen, T.; Mäkinen, Juha; Salonen, Markku

doi:10.1046/j.0001-5172.2001.00000.x-i2

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…With the use of these devices venous blood return and cardiac index increased significantly during CP in the head-up position [1]. Increasing intravascular volume by infusing of 500 ml of hydroxyethyl starch increased cardiac output in another nonrandomized clinical trial during gynecologic laparoscopy in the case of presumed decreased volume preload [23].…”

Section: Increasing Intrathoracic Blood Volumementioning

confidence: 99%

Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum

et al. 2006

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Section: Increasing Intrathoracic Blood Volumementioning

confidence: 99%

Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum

et al. 2006

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“…Volume preload diminishes the risk of gas embolism and of paradoxical embolism. [13] Ventilation-perfusion (V/Q) mismatch develops from the increase in physiologic dead space and hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide embolism during laparoscopic sleeve gastrectomy

Zikry

DeSousa

Alanezi

2011

J Anaesthesiol Clin Pharmacol

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Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG) in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO2 and SaO2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.

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“…Recently Tuppurainen et al [13] found that the infusion of volume during gynaecologic laparoscopy helps to normalise the pressure relationship between the arterial and to diminish the embolic risk. They monitored the movement of the interarterial septum with transoesophageal echocardiography during the procedure in twenty-one gynaecologic ASA 1±3 patients.…”

Section: Discussionmentioning

confidence: 99%

Transoesophageal Echocardiography for the Detection and Prevention of Embolic Episodes during Intramedullary Nailing for Pathological Fractures

2003

Osteosynthesis and Trauma Care

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The introduction of intramedullary nailing in clinical practice became popular at the beginning of the decade of 1980 and gave excellent results. Especially in patients with multiple injuries, their quick mobilisation had as a result the avoidance of complications in the respiratory system [6]. However, there are reports which show that intramedullary nailing can be associated with increased morbidity and mortality due to the appearance of embolic episodes; the most serious of these happen to patients with pathologic fractures [1,12]. Furthermore, in patients with a patent foramen ovale and right to left shunt, emboli can cross from the right to the left ventricle and cause paradoxical embolism with obstruction of the coronary and cerebral vessels [3,8].Transoesophageal echocardiography (TEE) is the most sensitive monitor for the detection of the embolic episodes intraoperatively [5,7,11] and gives an opportunity to research for the decrease of morbidity and mortality. In spite of its continuously increased use intraoperatively, there are rare studies in patients with pathological fractures and these include a small sample of patients. The aim of the present study is to investigate with the help of TEE the frequency and the seriousness of embolic episodes in patients who were submitted for intramedullary nailing for pathological fractures. Material and MethodsThe research started in May 1997 and until now 22 patients with pathological fractures were studied, 10 women and 12 men, with a mean age of 56 years (40 to 72). The patients were submitted for intramedullary nailing of femur, tibia and humerus. 10 pa- AbstractWe performed transoesophageal echocardiography on 22 patients during intramedullary nailing for pathological fractures. Moderate quantities of echogenic signals as a rosary in the screen of TEE (D = 1 mm) were observed in 10 patients during the opening of the bone marrow. Embolic episodes as a snowball (D = 1±5 mm) were observed in all patients during the intramedullary reaming and the introduction of the nail. The haemodynamic changes were related with the duration of the embolism. Two patients developed haemodynamic disorders, treated with 100 % O 2 and vasoconstrictors. Seven patients developed transient but not significant changes of arterial pressure, SaO 2 and P E CO 2. Paradoxical embolisation or fat embolism syndrome were observed in no patients. In one of these patients a flow-patent foramen ovale was detected preoperatively. During the operation and after intravenous fluid loading the right to left shunt flow could not be detected. This may represent a mechanism whereby paradoxical embolisation could be prevented intraoperatively. Transoesophageal echocardiography in intramedullary nailing for pathological fractures may play a useful role in the recording and anaesthesiological treatment of embolic episodes, venous and paradoxical, during these operations.

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Reducing the risk of systemic embolization during gynecologic laparoscopy − effect of volume preload

Cited by 6 publications

References 27 publications

Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum

Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum

Carbon dioxide embolism during laparoscopic sleeve gastrectomy

Transoesophageal Echocardiography for the Detection and Prevention of Embolic Episodes during Intramedullary Nailing for Pathological Fractures

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