Carbon dioxide embolism during endoscopic saphenous vein harvesting in coronary artery bypass surgery.
OBJECTIVE
Our objectives were to determine the incidence and severity and the time course of the CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation in coronary artery bypass surgery with transesophageal echocardiography monitoring.


METHODS
Four hundred three consecutive patients scheduled for off-pump coronary artery bypass grafting surgery or femoral-to-popliteal artery bypass grafting surgery were prospectively studied. Multiplane transesophageal echocardiography with a new transgastric view was used to monitor CO(2) bubbles in the inferior vena cava and hepatic vein.


RESULTS
CO(2) embolisms occurred in 17.1% of patients. Minimal, moderate, and massive CO(2) embolisms occurred in 13.1%, 3.5%, and 0.5%, respectively. The occurrence of moderate and massive CO(2) embolisms was frequently associated with the surgical manipulation of branches of saphenous veins. No significant risk factors were identified in multiple logistic regression analysis.


CONCLUSIONS
The incidence of significant CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation procedures was more than 4%. Continuous transesophageal echocardiographic monitoring of the CO(2) bubbles in the inferior vena cava is essential in early detection and can help to prevent the development of significant CO(2) embolisms in these patients.
Lin
Tzu-Yu
TY
Department of Anesthesia, Far Eastern Memorial Hospital, Taiwan.
Chiu
Kuan-Ming
KM
Wang
Ming-Jiuh
MJ
Chu
Shu-Hsun
SH
D000368:Aged; D002245:Carbon Dioxide; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D008297:Male; D016343:Monitoring, Intraoperative; D012501:Saphenous Vein / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging
D002245:Carbon Dioxide