title: Effect of carbon dioxide insufflation on free internal thoracic artery flows: is it a vasodilator?
abstract: BACKGROUND
  This study was conceived to evaluate the effect of carbon dioxide insufflation on free internal thoracic artery flows.
  
  
  METHODS
  We studied 56 consecutive patients who underwent coronary artery bypass grafting in which the left internal thoracic artery was anastomosed to the left anterior descending artery. The first 26 consecutive internal thoracic arteries were harvested as a pedicled graft (group 1), and the next 30 consecutive internal thoracic arteries were dissected by using the carbon dioxide insufflation technique (group 2). The internal thoracic artery harvesting was performed by 2 experienced surgeons by using the same instrumentation and technique. First, free flows of the internal thoracic arteries were registered after distal cutting of the vessel in both groups. After the first measurements, diluted papaverine was sprayed on the internal thoracic artery pedicle only in group 1, and then second measurements were registered after 15 minutes in both groups. Hemodynamic parameters were recorded with each measurement.
  
  
  RESULTS
  The first free flow measurement was significantly higher in the carbon dioxide-insufflated internal thoracic arteries (group 2, 60 +/- 32 mL/min; group 1, 28 +/- 19 mL/min; P <.05). Although the second free flow measurement of the carbon dioxide-insufflated group was higher than in group 1, the difference was not statistically significant (68 +/- 46 mL/min vs 53 +/- 32 mL/min; P =.53).
  
  
  CONCLUSIONS
  Carbon dioxide insufflation of the internal thoracic artery is an efficient technique to increase the flow and seems to be safe, simple, and reliable. When the internal thoracic artery is harvested in a carbon dioxide-insufflated fashion, arterial spasm and reduced early flow may be avoided, even without vasodilator agents such as papaverine.
authors.affiliation: Department of Cardiovascular Surgery, Ozel Karadeniz Hospital, Trabzon, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkan
authors.forename: Ismail
authors.initials: I
authors.lastname: Koramaz
authors.forename: A Tulga
authors.initials: AT
authors.lastname: Ulus
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tavil
authors.forename: Hakan
authors.initials: H
authors.lastname: Filizlioglu
authors.forename: Emre C
authors.initials: EC
authors.lastname: Baykan
authors.forename: Sadik
authors.initials: S
authors.lastname: Eryilmaz
authors.forename: Bahadir
authors.initials: B
authors.lastname: Inan
authors.forename: S Fehmi
authors.initials: SF
authors.lastname: Katircioglu
authors.forename: Umit
authors.initials: U
authors.lastname: Ozyurda
mesh_terms: D002245:Carbon Dioxide / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000187:drug effects; D013895:Thoracic Arteries / Q000187:drug effects* / Q000502:physiology*; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D014665:Vasodilator Agents; D002245:Carbon Dioxide