title: Detection of subclinical CO2 embolism by transesophageal echocardiography during laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To document incidences of subclinical embolism in laparoscopic radical prostatectomy with continuous monitoring using transesophageal echocardiography (TEE).
  
  
  METHODS
  A total of 43 patients scheduled for elective robotic-assisted laparoscopic radical prostatectomy under general anesthesia were enrolled in this study. A 4-chamber view of 5.0-MHz multiplane TEE was continuously monitored to detect any intracardiac bubbles as an embolism. An independent TEE specialist reviewed the tapes for interpretation, and emboli were classified as 1 of 5 stages. Cardiorespiratory instability during gas emboli entry was defined as an appearance of cardiac arrhythmias, sudden decrease in mean arterial blood pressure >20 mm Hg, or an episode of pulse oximetric saturation <90%.
  
  
  RESULTS
  Gas embolisms were observed in 7 of 41 (17.1%) patients during transection of the deep dorsal venous complex. Of them, 1, 3, 1, and 2 showed stage I, II, III, and IV, respectively. However, there were no signs of cardiorespiratory instability associated with emboli. The 95% confidence interval for gas embolism was 0.204%-0.138%. No correlation was observed between episodes of gas embolism and blood gas variables or end-tidal CO(2) partial pressure.
  
  
  CONCLUSIONS
  Subclinical gas embolisms occur in 17.1% of laparoscopic radical prostatectomies. We should consider that this procedure has a potential for serious gas embolism, especially with the increasing popularity of laparoscopic prostatectomy using robot-assisted techniques.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong-Yeon
authors.initials: JY
authors.lastname: Hong
authors.forename: Won Oak
authors.initials: WO
authors.lastname: Kim
authors.forename: Hae Keum
authors.initials: HK
authors.lastname: Kil
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D010535:Laparoscopy; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*
chemical_list: D002245:Carbon Dioxide