Haemodynamic effects during endoscopic vein harvest of the saphenous vein for off-pump coronary artery bypass grafting surgery.
OBJECTIVE
Endoscopic vein harvest (EVH) for coronary artery bypass grafting surgery is performed with carbon dioxide (CO2) insufflation for visualization and dissection. The insufflated CO2 is rapidly absorbed into the body and may influence haemodynamics. However, the haemodynamic changes during EVH have not been clearly defined. This study evaluated the haemodynamic effects during EVH of the saphenous vein for off-pump coronary artery bypass grafting surgery (OPCAB).


METHODS
After fixing the position for harvesting of the left internal mammary artery, EVH of the saphenous vein was performed at a maximum CO2 pressure of 12 mmHg and a flow of 3 l/min. The haemodynamic parameters were measured before and just after the end of endoscopic vein harvest.


RESULTS
One hundred patients were studied. The end-tidal CO2 pressure (P(ET)CO2, 35.0 +/- 2.7 vs. 52.0 +/- 6.2 mmHg), partial pressure of arterial CO2 (PaCO2, 35.1 +/- 3.1 vs. 52.5 +/- 4.3 mmHg), mixed venous oxygen saturation (SvO2, 75.6 +/- 4.1 vs. 82.0 +/- 1.6%), cardiac index (2.7 +/- 0.6 vs. 3.3 +/- 0.6 l/min/m2), and cerebral oxygen saturation (ScO2, left: 63.5 +/- 7.9 vs. 73.3 +/- 8.4; right: 62.2 +/- 8.0 vs. 72.3 +/- 6.3%) differed significantly between before and after CO2 insufflation, whereas mean systemic blood pressure, mean pulmonary artery blood pressure, central venous pressure, heart rate, partial pressure of arterial oxygen, and peak inspiratory pressure did not differ significantly between before and after CO2 insufflation.


CONCLUSIONS
EVH, at a maximum CO2 pressure of 12 mmHg and a flow of 3 l/min, of the saphenous vein for OPCAB was associated with hypercarbia and a tolerable range of hypercarbia (PaCO2 < 60 mmHg) increased the cardiac index and ScO2 without any complications.
Kim
Seong-Hyop
SH
Department of Anaesthesiology and Pain Medicine, School of Medicine, Konkuk University, Seoul, Korea.
Kim
Duk-Kyung
DK
Yoon
Tae-Gyoon
TG
Lim
Jeong-Ae
JA
Woo
Nam-Sik
NS
Kim
Tae-Yop
TY
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage*; D002496:Central Venous Pressure; D001026:Coronary Artery Bypass / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D010313:Partial Pressure; D011446:Prospective Studies; D011651:Pulmonary Artery; D012501:Saphenous Vein / Q000637:transplantation*
D002245:Carbon Dioxide; D010100:Oxygen