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Elevated PEEP without effect upon gas embolism frequency or severity in experimental laparoscopic liver resection
D Fors1, K Eiriksson, D Arvidsson
1Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, SE-75185 Uppsala, Sweden. diddi.fors@akademiska.se
British Journal of Anaesthesia
|May 24, 2012
Summary
Positive end-expiratory pressure (PEEP) did not affect carbon dioxide (CO2) embolism during laparoscopic liver surgery. Gas embolism (GE) occurred regardless of the central venous pressure (CVP) to intra-abdominal pressure (IAP) gradient.
Area of Science:
- Surgical Anesthesiology
- Minimally Invasive Surgery
- Cardiopulmonary Physiology
Background:
- Carbon dioxide (CO2) embolism is a recognized risk during laparoscopic liver surgery.
- Gas embolism (GE) is hypothesized to occur when central venous pressure (CVP) is lower than intra-abdominal pressure (IAP).
Purpose of the Study:
- To determine if increasing CVP with positive end-expiratory pressure (PEEP) can reduce the incidence and severity of GE during laparoscopic liver resection.
Main Methods:
- Twenty piglets underwent laparoscopic liver resection with a standardized hepatic vein injury.
- Animals were randomized to receive either 5 or 15 cm H2O PEEP.
- Hemodynamic, respiratory, and arterial blood gas variables were monitored; transesophageal echocardiography assessed GE occurrence and severity.
Main Results:
- No significant difference in the frequency or severity of GE was observed between the 5 cm H2O PEEP and 15 cm H2O PEEP groups.
- Gas embolism occurred independently of the CVP-IAP gradient during both the venous cut and the remainder of the surgery.
Conclusions:
- The CVP-IAP gradient is not the sole determinant of CO2 embolism formation during laparoscopic liver surgery.
- Anesthetic management strategies should consider factors beyond the CVP-IAP gradient to mitigate GE risk.
