[Experimental studies on respiratory insufficiency after endoscopic injection sclerotherapy using...

To study the influence of Ethanolamine-Oleate (EO) used for endoscopic injection sclerotherapy for esophageal varices on the pulmonary hemodynamics, extra vascular lung water (EVLW), and pulmonary and systemic pressures measurements, and blood gas analysis were performed after injection of EO directly into the right atrium in 18 mongrel dogs. Studies were made in three groups, group A (6 dogs) in which the bolus of 1 ml/kg of EO was injected with 1 second; group B (6 dogs) in which 0.25 ml/kg of EO was injected for four times successively within a minute; and controls (6 dogs) the bolus of 1 ml/kg of saline was injected within 1 second. EVLW was measured by thermal-green dye double indicator dilution method. Pulmonary pressures were measured using Swan-Ganz catheter. Results were as follows. In group A, 4 of the 6 dogs died with a symptom of pulmonary edema within several minutes. In the other two, systemic and pulmonary artery pressure did not change, but EVLW and pulmonary artery resistance significantly increased compared to the controls. Intrapulmonary shunt ratio and PO2 were reduced significantly compared to the controls. In group B no systemic hemodynamic changes were observed. But again EVLW significantly increased. These results suggest that the injection sclerotherapy using EO affects pulmonary hemodynamics. And this effect of EO doesn't depend on the total amount of injected EO, but on the concentration of EO reaching the lung. Careful respiratory monitoring seems necessary in patients undergoing injection sclerotherapy.