Richter Steffen, Hückstädt Thomas, Aksakal Devrim, Klitscher Daniela, Wowra Tobias, Till Holger, Schier Felix, Kampmann Christoph
Department of Pediatric Surgery, University Medical Center, Liebigstrasse 20a, Leipzig, Germany.
J Laparoendosc Adv Surg Tech A. 2012 Oct;22(8):824-9. doi: 10.1089/lap.2012.0029. Epub 2012 Sep 18.
Helium is used as an insufflation gas to avoid the negative properties of carbon dioxide (CO(2)), such as CO(2) accumulation, acidosis, and tachycardia, particularly in the case of insufficient respiratory function, seen also in infancy. Any laparoscopic procedure carries the risk of a gas embolism.
Seven anesthetized piglets (weighing 9.9-12.8 kg), randomized into three groups, served as models for pre-teenage children. Three piglets received a CO(2) embolism, followed by a helium embolism of 2 mL/kg, respectively. Helium was administered to three piglets, whereas both gases were repeatedly administered alternately to one piglet. The embolisms were administered for 30 seconds via a central venous line. Cardiac output was measured using the thermodilution method. The observation period for each embolism was 60 minutes in Groups 1 and 2 and 15 minutes in Group 3.
All animals survived CO(2) embolisms. Four of the six piglets died after helium embolisms. Following helium embolisms there was a prompt initial decrease in the end-tidal CO(2) pressure and an initial increase in the pulmonary arterial pressure. A further decrease in arterial blood pressure was prevented by a compensatory increase in the heart rate and appeared just before death. After only 5 minutes cardiac output showed a 25% decline from the initial value. Helium embolisms led to a severe increase in the pulmonary dead space.
Embolisms with the smallest amounts of helium administered via direct venous puncture have an immediate lethal impact. Extended perioperative monitoring and trocar placement under vision should be performed.
氦气被用作注入气体，以避免二氧化碳（CO₂）的负面特性，如CO₂蓄积、酸中毒和心动过速，尤其是在呼吸功能不全的情况下，这种情况在婴儿期也可见。任何腹腔镜手术都有气体栓塞的风险。
七只麻醉的仔猪（体重9.9 - 12.8千克），随机分为三组，作为青少年前儿童的模型。三只仔猪分别接受CO₂栓塞，随后接受2毫升/千克的氦气栓塞。给三只仔猪注入氦气，而对一只仔猪交替重复注入两种气体。通过中心静脉导管进行30秒的栓塞注入。使用热稀释法测量心输出量。第1组和第2组每次栓塞的观察期为60分钟，第3组为15分钟。
所有动物在CO₂栓塞后均存活。六只仔猪中有四只在氦气栓塞后死亡。氦气栓塞后，呼气末CO₂压力立即出现初始下降，肺动脉压力出现初始升高。心率的代偿性增加阻止了动脉血压的进一步下降，且在死亡前才出现。仅5分钟后，心输出量就比初始值下降了25%。氦气栓塞导致肺死腔严重增加。
通过直接静脉穿刺注入最少量的氦气栓塞具有立即致命的影响。应进行延长的围手术期监测并在直视下放置套管针。
