Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, SE-75185 Uppsala, Sweden.
Br J Anaesth. 2012 Aug;109(2):272-8. doi: 10.1093/bja/aes129. Epub 2012 May 22.
Carbon dioxide (CO(2)) embolism is a potential complication in laparoscopic liver surgery. Gas embolism (GE) is thought to occur when central venous pressure (CVP) is lower than the intra-abdominal pressure (IAP). This study aimed to investigate whether an increased CVP due to induction of PEEP could influence the frequency and severity of GE during laparoscopic liver resection.
Twenty anaesthetized piglets underwent laparoscopic left liver lobe resection and were randomly assigned to either 5 or 15 cm H(2)O PEEP (n=10 per group). During resection, a standardized injury to the left hepatic vein [venous cut (VC)] was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored, and online arterial blood gas monitoring and transoesophageal echocardiography (TOE) were used. The occurrence and severity of embolism was graded as 0 (none), 1 (minor), or 2 (major), depending on the TOE results.
No differences were found between the two groups regarding the frequency or severity of GE, during either the VC (P=0.65) or the rest of the surgery (P=0.24). GE occurred irrespective of the CVP-IAP gradient.
Mechanisms other than the CVP-IAP gradient seemed during laparoscopic liver surgery to contribute to the formation of CO(2) embolism. This is of clinical importance to the anaesthetists.
二氧化碳（CO(2)）栓塞是腹腔镜肝手术的潜在并发症。当中心静脉压（CVP）低于腹腔内压（IAP）时，被认为会发生气体栓塞（GE）。本研究旨在探讨由于呼气末正压通气（PEEP）引起的 CVP 升高是否会影响腹腔镜肝切除术中 GE 的频率和严重程度。
20 只麻醉小猪接受腹腔镜左肝叶切除术，并随机分为 5 或 15 cm H(2)O PEEP 组（每组 10 只）。在切除过程中，对左肝静脉进行标准化损伤[静脉切割（VC）]，以增加 GE 的风险。监测血流动力学和呼吸变量，并使用在线动脉血气监测和经食管超声心动图（TOE）。根据 TOE 结果，栓塞的发生和严重程度分为 0（无）、1（轻微）或 2（严重）。
两组在 VC 期间（P=0.65）或手术其余时间（P=0.24）的 GE 频率或严重程度均无差异。GE 的发生与 CVP-IAP 梯度无关。
在腹腔镜肝手术中，似乎除了 CVP-IAP 梯度之外的其他机制有助于 CO(2)栓塞的形成。这对麻醉师具有临床重要意义。
