| Detection of Carbon Dioxide Embolism Using Transesophageal Echocardiography during Thoracoscopic Sympathicotomy. |
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Chung Hyun Park, Jong Yun Lee, Yong Chan Kim, Seung Ho Kim, Keum Hee Jung, Min Goo Kim, Hyeon Jae Lee |
1Department of Anesthesia and Pain Medicine, College of Medicine, Pochun CHA University, Pocheon, Korea. anesthpark@hanmail.net
2Department of Cardiothoracic Surgery, College of Medicine, Pochun CHA University, Pocheon, Korea. |
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| Abstract |
BACKGROUND
Thoracoscopic Sympathicotomy (TS) is widely accepted as an effective method for the treatment of palmar hyperhidrosis. Single lumen endotracheal tube using CO2 insufflation is a simple and safe method for thoracoscopic surgery. However, there are chances of CO2 embolism during CO2 insufflation and nerve dissection. The object of this study were to assess the incidence of embolic events using transesophageal echocardiography (TEE) and to evaluate the related cardiorespiratory consequence during TS.
METHODS
Thirty-two patients undergoing TS were studied. The long axis four chamber view was obtained continuously, except for predetermined intervals (after induction, CO2 insufflation in left thoracic cavity, left sympathicotomy, CO2 insufflation in right thoracic cavity, and right sympathicotomy) where the transgastric short axis view was obtained to derive ejection fraction (EF). Heart rate, mean arterial pressure (MAP), O2 saturation, and end tidal CO2 were monitored. Statistical analysis was performed using multivariated ANOVA and unpaired Student's t-test. P < 0.05 was considered significant.
RESULTS
We observed CO2 embolism in 28/32 patients during CO2 insufflation (left or right) and in 32/32 patients during nerve dissection (left or right). There was no significant difference in cardiorespiratory variables between patients who presented embolism and who did not, during four distinct periods of events. Meanwhile, MAP decrease (P = 0.002) and EF increased significantly (P = 0.007) after sympathicotomy. This can be explained by decrease in systemic vascular resistance (SVR) by sympathicotomy.
CONCLUSIONS
Embolic events commonly occur during CO2 insufflation and nerve dissection without cardiorespiratory instability during TS. However, we should pay attention when administrating N2O. |
| Key Words:
CO2 embolism; thoracoscopic sympathicotomy; transesophageal echocardiography |
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