Carbon dioxide insufflation and neurocognitive outcome of open heart surgery

Ganguly, Gautam; Dixit, Vikas; Patrikar, Seema; Venkatraman, Ravishankar; Gorthi, Satya Prakash; Tiwari, Nikhil

doi:10.1177/0218492315583562

Cited by 17 publications

(26 citation statements)

References 17 publications

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“…Ganguly et al recommend that CO 2 insufflation be performed in all open heart surgery cases to bring down the incidence of neurocognitive dysfunction. Also, they reported no requirement of major paraphernalia or additional costs with this technique [ 6 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of carbon dioxide insufflation on anastomosis remodeling at a carotid artery site in rabbits

Gencpinar

Akkaya

Bilen

et al. 2018

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IntroductionUse of carbon dioxide (CO2) insufflation (CDI) on the surgical field during heart surgery has become widespread, and in some units routine.AimTo assess the effects of CDI on endothelial dysfunction in a carotid artery model in rabbits.Material and methodsTwelve randomly selected rabbits were divided into two groups. Right carotid arteries of the animals were transected and sutured with running suture technique. Then, 1 l/min CO2 insufflation was initiated with a 45° angle. In the control group, the anastomotic field was irrigated with 0.1 ml/s flow of 0.9% saline. At day 28, the carotid artery segments were removed and prepared for histological specimens.ResultsIn the cross-sections of the control group vessel samples, thickening of the tunica intima was observed. Scoring the quantity of endothelial nitric oxide synthase (e-NOS) and α-smooth muscle actin (α-SMA) positive staining revealed a nonsignificant difference between the experimental groups (p = 0.07). In the CO2 group, the intimal hyperplasia (p = 0.2) and the thickness of the tunica media (p = 0.2) were indistinguishable when compared to the control group. The mean luminal diameters and luminal areas of the experimental groups were all evaluated by histomorphometry and a significant differences was found between luminal areas (p = 0.016). On the other hand, no significant difference was found between mean luminal diameters (p = 0.055).ConclusionsOur study indicated that CDI can affect endothelial cell damage and the mean luminal diameters.

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Section: Discussionmentioning

confidence: 99%

Effects of carbon dioxide insufflation on anastomosis remodeling at a carotid artery site in rabbits

Gencpinar

Akkaya

Bilen

et al. 2018

kitp

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“…Surgical patients are getting older, with comorbidities, and the inflammatory effects of CPB can also contribute to neurocognitive impairment. 6,14 Improvements in extracorporeal equipment as well as perfusion and surgical techniques have led to a dramatic reduction of GME. 13,17 Several studies have been done to investigate the link between GME from CPB and postoperative cognitive decline, but they have been summarized and can neither confirm nor rule out a causal link.…”

Section: Discussionmentioning

confidence: 99%

“…11-13 Flushing the bypass circuit with CO 2 before priming with fluid may reduce the amount of GME and decrease the time to de-air the circuit. 14,15 Few studies have been done to evaluate this routine and effect. 9…”

Section: Introductionmentioning

confidence: 99%

Measurement of gaseous microemboli in the prime before the initiation of cardiopulmonary bypass

et al. 2017

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“…After detailed evaluation of these articles, 12 studies remained for assessment. After applying the selection criteria, 8 RCTs [14][15][16][17][18][19][20][21] were selected for analysis ( Figure 1). The study characteristics of these trials are summarized in Table 1,2 and 3.…”

Section: Quantity and Quality Of Trialsmentioning

confidence: 99%

Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Benedetto

Caputo

Guida

et al. 2017

Seminars in Thoracic and Cardiovascular Surgery

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Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac surgery, there is still paucity of evidence to prove its benefit in terms of neurologic protection. Therefore, we conducted a meta-analysis of available randomized controlled trials comparing CDI vs standard de-airing maneuvers. Electronic searches were performed to identify relevant randomized controlled trials. Primary outcomes investigated were postoperative stroke, neurocognitive deterioration, and in-hospital mortality. Risk difference (RD) was used as summary statistic. Pooled estimates were obtained by means of random-effects model to account for possible clinical diversity and methodological variation between studies. Eight studies were identified with 668 patients randomized to CDI (n = 332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was 2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95% confidence interval [CI] -2% to 2%; P = 0.87; I = 0%). Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62; I = 0%). Neurocognitive deterioration rate was 12% vs 21% in the CDI and control group, respectively, but this difference was not statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35; I = 0%). The present meta-analysis did not find any significant protective effect from the use of CDI when compared with manual de-airing maneuvers in terms of clinical outcomes, including postoperative neurocognitive decline.

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Carbon dioxide insufflation and neurocognitive outcome of open heart surgery

Cited by 17 publications

References 17 publications

Effects of carbon dioxide insufflation on anastomosis remodeling at a carotid artery site in rabbits

Effects of carbon dioxide insufflation on anastomosis remodeling at a carotid artery site in rabbits

Measurement of gaseous microemboli in the prime before the initiation of cardiopulmonary bypass

Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

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