Cerebral Carbon Dioxide Embolism During Laparoscopic Cholecystectomy

Schindler, Ehrenfried; Müller, M; Kelm, C

doi:10.1097/00132586-199604000-00070

Cited by 3 publications

(4 citation statements)

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“…Most of the embolism occurs during the initial insufflation of CO 2 or during the dissection phase of the gallbladder. There is evidence that CO 2 bubbles are capable of reaching the right side of the heart ( 15–18). When studied with transoesohageal echocardiography, 68% of patients have CO 2 bubbling in the right chamber of the heart during laparoscopic cholecystectomy ( 15, 16).…”

Section: Aberrant Effects Of Co2mentioning

confidence: 99%

“…When studied with transoesohageal echocardiography, 68% of patients have CO 2 bubbling in the right chamber of the heart during laparoscopic cholecystectomy ( 15, 16). Transcranial Doppler has shown that CO 2 bubbles may reach even the cerebral circulation ( 17). Gas emboli are able to escape from the venous side to the arterial circulation through the pulmonary arterio‐venous shunting ( 19) or foramen ovale ( 20).…”

Section: Aberrant Effects Of Co2mentioning

confidence: 99%

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Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy

Koivusalo

Lindgren

2000

Acta Anaesthesiol Scand

103

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L APAROSCOPY is ''the golden standard'' in treating symptomatic gallstones. Because the postoperative benefits are superior to open cholecystectomy, laparoscopy is today also used in patients with underlying diseases. To be able to treat this challenging patient population, we should be aware of physiological alterations caused by carbon dioxide (CO 2) insufflation and elevated intra-abdominal pressure (IAP). It is now commonly accepted that pneumoperitoneum causes intraoperative adverse cardiovascular, respiratory and renal effects. Some of these effects are related to CO 2 and some to elevated IAP. CO 2 is the preferred gas for the creation of pneumoperitoneum because it is inexpensive, highly soluble, chemically stable, rapidly eliminated, physically inert, suppresses combustion and also provides fairly good illumination. CO 2 is a normal product of human metabolism and at physiological levels non-toxic.

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Section: Aberrant Effects Of Co2mentioning

confidence: 99%

Section: Aberrant Effects Of Co2mentioning

confidence: 99%

Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy

Koivusalo

Lindgren

2000

Acta Anaesthesiol Scand

103

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“…Other methods of early detection of paradoxical gas embolism have been reported during laparoscopic cholecystectomy; by transesophageal echocardiography 15 and by transcranial Doppler. 16 In our second case, in which a patent foramen ovale was ruled out, the decrease of BIS and entropy was observed after hemodynamic and respiratory parameters changed and was transient, reflecting a decrease in cardiac output as a result of gas embolization.…”

Section: Detection Of Gas Embolism By Bispectral Index and Entropy Mo...mentioning

confidence: 57%

“…References 27 and 33-35 in our original article 1 provide support for our opinion. Many other studies support our position that ␣ agonists can increase venous return [12][13][14][15][16][17] ; some focus on the matter in dispute. Stokland et al, 12 using a model in which preload was controllable, showed that two thirds of the phenylephrine-induced increase in blood pressure resulted from increased preload, whereas only one third was from increased peripheral vascular resistance.…”

Section: Do Alpha Agonists Increase Venous Return?mentioning

confidence: 63%

High Incidence of Myocardial Ischemia during Postpartum Hemorrhage or Poor Management of Hemorrhagic Shock?

Frölich¹

2004

Anesthesiology

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To the Editor:-We read with interest the case report by Cladis and Litman 1 regarding the intravascular injection of 3% 2-chlorprocaine. The authors are to be congratulated on their ability to postoperatively radiologically document the intravascular placement of the epidural catheter. However, we have concerns with the total dose of 2-chloroprocaine used. The authors state that they injected 4 ml 2-chlorprocaine, 3%, over approximately 30 s. When this dose is calculated on a per-kilogram basis for the 2-month-old, 4-kg child described in the case report, the dose is 30 mg/kg for a total dose of 120 mg.Neonates and infants up to 6 months of age have approximately half the plasma cholinesterase of older children. 2 Singler 3 suggests a maximum of 7 mg/kg 2-chlorprocaine in infants. Although the rapidity of the cardiac toxicity after administration of the local anesthetic suggests an intravascular injection, the 4 ml 2-chloroprocaine, 3%, seems large enough that it was rapidly absorbed from the epidural space, producing a transient peak blood level and causing the transient cardiovascular effects. Rapidity of development of peak serum concentrations of local anesthetics is known to be related to the site of injection, with intercostal being the fastest, followed by caudal and then epidural. 4 Because no blood was aspirated from the epidural catheter on two occasions does not mean that the catheter was not in an epidural vein. It is possible that the catheter migrated into the vein during the case and was found postoperatively. 5 However, regardless of the catheter placement, we believe that the total dose was too large for the patient.

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ОБЗОРЫ НА Ратан-600 И КОСМОЛОГИЧЕСКИЙ ГЕН, "Астрономический Журнал"

Верходанов¹,

Парийский²

2017

Астрономический журнал

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Cerebral Carbon Dioxide Embolism During Laparoscopic Cholecystectomy

Cited by 3 publications

References 0 publications

Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy

Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy

High Incidence of Myocardial Ischemia during Postpartum Hemorrhage or Poor Management of Hemorrhagic Shock?

ОБЗОРЫ НА Ратан-600 И КОСМОЛОГИЧЕСКИЙ ГЕН, "Астрономический Журнал"

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