Department of Anesthesiology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060-8543, Japan.
J Anesth. 2010 Feb;24(1):114-6. doi: 10.1007/s00540-009-0847-z.
We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism.
我们报告了一例在非体外循环冠状动脉旁路移植术（OPCAB）中由二氧化碳（CO2）吹气机引起的肺栓塞（PE）的罕见病例。当进行右内乳动脉与前降支吻合时，术者撕裂了与前降支相邻的右心室流出道（RVOT）。在使用 CO2 吹气机吻合和修复撕裂的 RVOT 后，收缩期肺动脉压（PAP）从 28mmHg 增加到 64mmHg，呼气末 CO2 从 32mmHg 减少到 12mmHg。由于经食管超声心动图（TEE）显示主肺动脉内有大量气泡，我们诊断为 CO2 气泡通过撕裂的 RVOT 侵入引起的 PE。尽管 CO2 吹气机在 OPCAB 中有助于增强吻合口的可视化，但不应将其用于静脉系统，因为它可能导致 CO2 栓塞。
