title: Hazards with electrocautery-induced decomposition of fatty acids--in view of lipid embolization.
abstract: OBJECTIVE
  Electrocautery is an appreciated surgical tool, which however, generates immense heat and fat-tissue melting. In cardiac surgery, liquefied fat collects on the surface of blood in the pericardial cavity and becomes aspirated by the heart-lung machine for aortic recycling. Deposits seen in the brain microcirculation after surgery are caused by lipid embolism. This study investigates lipid chemistry, whether heat from electrocautery generates fatty-acid fragmentation and decomposition.
  
  
  METHODS
  Pericardial fat tissue was sampled from cardiac-surgery patients and from piglets. The human tissue was exposed to electrocautery, or to fixed temperatures in an in vitro model. Fatty-acid decomposition was explored by solid-phase microextraction gas chromatography and the distribution of fatty acids was measured.
  
  
  RESULTS
  Fatty-acid decomposition demonstrated a temperature-effect relationship (p = 0.007). At 350°C the proportion of polyunsaturated fatty acids became heavily reduced or were abolished (p = 0.016). Electrocautery resulted in similar changes.
  
  
  CONCLUSIONS
  Electrocautery induces a profound fatty-acid fragmentation to form short-chained compounds. The chemical and toxic nature of these compounds remains to be determined, including their clinical implications at blood recycling in cardiac surgery.
authors.affiliation: Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden. gunnar.engstrom@vll.se
authors.forename: Karin
authors.initials: K
authors.lastname: Engström
authors.forename: Karl Gunnar
authors.initials: KG
authors.lastname: Engström
mesh_terms: D000273:Adipose Tissue / Q000737:chemistry; D000368:Aged; D000818:Animals; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D004564:Electrocoagulation / Q000009:adverse effects*; D004620:Embolism, Fat / Q000209:etiology*; D005227:Fatty Acids / Q000737:chemistry*; D006358:Hot Temperature; D006801:Humans; D008297:Male; D010496:Pericardium / Q000737:chemistry; D013552:Swine
chemical_list: D005227:Fatty Acids