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Ann Thorac Surg 2006;81:1697-1699
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Reduction of Carbon Dioxide Embolism for Endoscopic Saphenous Vein Harvesting

^a Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
^b Department of Anesthesia, Far Eastern Memorial Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
^c Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Accepted for publication December 9, 2005.

^_* Address correspondence to Dr Wang, Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan South Road, Taipei, Taiwan 100; (Email: canon{at}ha.mc.ntu.edu.tw).

BACKGROUND: The endoscopic saphenous vein harvesting (EVH) introduced in coronary artery bypass surgery (CABG) is associated with less wound complication and postoperative pain. Carbon dioxide (CO₂) insufflation is used during EVH to facilitate the procedure. The purpose of this study was to determine whether the incidence of CO₂ embolism during EVH with CO₂ insufflation could be reduced with lower CO₂ insufflation pressure.

METHODS: Four hundred and ninety-eight consecutive patients scheduled for elective off-pump CABG were prospectively studied. These patients were randomly assigned into high and low groups in which 15 and 12 mm Hg CO₂ insufflation pressures were used during EVH, respectively. Multiplane transesophageal echocardiography (TEE) with transgastric inferior vena cava view was used to monitor the appearances of CO₂ bubbles. If a burst of many CO₂ bubbles were found by TEE, the CO₂ insufflation would be stopped until detailed examination of the operative field.

RESULTS: The incidence of CO₂ embolisms in the high group of patients (13.3%) was significantly higher than that in the low group (6.5%, p < 0.05). Two episodes of emergent cessation of CO₂ insufflation occurred in the high group of patients. No massive CO₂ embolism with significant hemodynamic alterations occurred in either group.

CONCLUSIONS: The incidence of CO₂ embolisms during EVH could be reduced with lower CO₂ insufflation pressure, which, in combination with increased surgical experience and continuous TEE monitoring of the inferior vena cava, helps to reduce the risks of massive CO₂ embolism.

This article has been cited by other articles:

				J. J. Andreasen, V. Nekrasas, and C. Dethlefsen Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a prospective randomized trial. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 384 - 389. [Abstract] [Full Text] [PDF]

				M. Tamim, M. Omrani, A. Tash, and A. El Watidy Carbon dioxide embolism during endoscopic vein harvesting Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 659 - 660. [Abstract] [Full Text] [PDF]

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