Key result
TEE detects subclinical venous CO2 embolism in ~100% of patients during gallbladder dissection.
Why the study?
Although major gas embolism is rare during laparoscopic cholecystectomy, the incidence of less severe, subclinical episodes of venous carbon dioxide embolism and their potential cardiorespiratory consequences were unknown.
What is the incidence of subclinical venous carbon dioxide embolism detected by transesophageal echocardiography and its hemodynamic consequence in patients undergoing laparoscopic cholecystectomy?
Observational (n=20)
No
What is the incidence of subclinical venous carbon dioxide embolism detected by transesophageal echocardiography and its hemodynamic consequence in patients undergoing laparoscopic cholecystectomy?
Answers are grounded in this paper and cite their sources.
Subclinical venous CO2 embolism occurs universally during gallbladder dissection in laparoscopic cholecystectomy without causing hemodynamic instability, whereas peritoneal insufflation itself significantly reduces left ventricular ejection fraction, warranting caution in patients with impaired cardiac function.
Background: Although major gas embolism has occurred rarely during laparoscopic cholecystectomy (LC), the incidence of less severe episodes of 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 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 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 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 embolic event.
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Park et al. (2006) conducted an observational in Patients undergoing laparoscopic cholecystectomy (n=20). Laparoscopic cholecystectomy (peritoneal CO2 insufflation and gallbladder dissection) monitored by transesophageal echocardiography vs. Baseline post-induction / non-embolic patients during insufflation was evaluated on Incidence of venous CO2 embolism on transesophageal echocardiography during gallbladder dissection. Transesophageal echocardiography detected subclinical venous CO2 embolism in 20% (4/20) of patients during peritoneal insufflation and 100% (20/20) during gallbladder dissection without hemodynamic instability.
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