A pause before connecting insufflation tubing to decrease the risk of air embolism.

Area of Science:

• Minimally invasive surgery
• Surgical safety
• Anesthesiology

Background:

• Air embolism is a rare but potentially fatal complication during laparoscopic surgery, particularly in pediatric patients.
• A common theory suggests ambient air in insufflation tubing enters the vascular system during trocar or Veress needle insertion.
• Current practice lacks guidelines for a delay between initiating CO2 flow and connecting tubing.

Purpose of the Study:

• To assess the time required for CO2 to reach the end of laparoscopic insufflation tubing at various flow rates and pressures.
• To determine if a delay in connecting tubing after initiating CO2 flow can prevent air embolism.

Main Methods:

• Standard laparoscopic insufflation tubing was connected to an insufflator and an end-tidal CO2 monitor.
• The time from initiating CO2 flow to a visible increase on the CO2 monitor was measured at different flow rates and pressures.
• Each test was repeated 10 times at each setting.

Main Results:

• The time for CO2 to reach the tubing's end ranged from 3.32 ± 0.27s to 3.46 ± 0.10s across clinically relevant settings.
• Minimal variation in timing was observed across different flow rates and pressures.
• This suggests a consistent delay before CO2 fully purges the tubing.

Conclusions:

• A waiting period of at least ten seconds is recommended between initiating CO2 flow and connecting the insufflation tubing.
• This delay ensures the absence of ambient air in the tubing, preventing air embolism.
• Adhering to this guideline can make air embolism a 'never event' in laparoscopic procedures.