Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
권호 표지

Transesophageal Echocardiographic Assessment of Venous Carbondioxide Embolism during Laparoscopic Cholecystectomy

복강경 담낭절제술 시 경식도심초음파를 이용한 이산화탄소 색전증의 평가

Park, Sa-Hyun;Park, Chung-Hyun;Song, Ji-Eun;Kim, Seung-Ho;Lee, Jong-Yeun;Kim, Myong-Hee
박사현;박정현;송지은;김승호;이종연;김명희

  • Published : 20060100
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Abstract

Background: Although major $CO_2$ gas embolism has occurred rarely during laparoscopic cholecystectomy (LC), the incidence of less severe episodes of $CO_2$ embolism is unknown. It is also possible that such gas embolism, if present, could affect to cardiorespiratory variables. This study was designed to assess the incidence of subclinical embolic events using transesophageal echocardiography (TEE) and to evaluate the related hemodynamic consequence during LC. Methods: With IRB approval, 20 patients undergoing LC were studied. The long axis four chamber view was obtained continuously, except for predetermined intervals where the transgastric short axis view was obtained to derive ejection fraction (EF). Heart rate, mean arterial pressure, O2 saturation, and end-tidal $CO_2$ were monitored. Statistical analysis was performed using multivariated ANOVA and unpaired Student's t-test. P ＜ 0.05 was considered significant. Results: We observed gas embolism in 4/20 patients during $CO_2$ insufflation and 20/20 patients during gallbladder (GB) dissection. There was no significant difference in cardiorespiratory variables between embolic and nonembolic patients during insufflation. Also there was no significant difference in cardiorespiratory variation in all patients with embolism between before and after GB dissection. EF decreased significantly after insufflation (P = 0.002) and was recovered after exsufflation (P = 0.001). This can be explained by increase in systemic vascular resistance (SVR). Conclusions: Embolic events commonly occur during $CO_2$ insufflation and GB dissection without cardiorespiratory instability. Although embolic event itself didn't affect the hemodynamic variables, peritoneal insufflation increased SVR and decreased EF. We should pay attention to patients undergoing LC who have decreased cardiac function and also prepare for serious $CO_2$ embolic event.

Keywords

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