title: Air in the insufflation tube may cause fatal embolizations in laparoscopic surgery: an animal study.
abstract: BACKGROUND
  The aim of this study was to evaluate the risk of an air embolization with the volume of the insufflation tube during induction of laparoscopy. A further objective was to determine the LD₅₀ of air in young piglets.
  
  
  METHODS
  End-tidal carbon dioxide pressure ([Formula: see text]), pulmonary arterial pressure (P pa), heart rate (f c), and mean arterial pressure (P a carot) were measured in 17 piglets divided into three groups: group 1 (n = 6), bolus application (CO₂ embolization, followed by air embolization, 2 mL/kg each), group 2 (n = 7), continuous air embolization (30 min, 0.2 mL/kg/min), and group 3 (n = 4), continuous CO₂ embolization (30 min, 0.4 mL/kg/min).
  
  
  RESULTS
  All animals survived CO₂ embolism. Air embolization as a bolus (2 mL/kg) or with an accumulated volume of 3.1 mL/kg led to death. Decreases in [Formula: see text] indicated air or massive CO₂ embolization only. There was a good correlation between [Formula: see text] and P pa in case of air embolization (r = -0.80, p < 0.0001). In contrast, no dependency was recognized during CO₂ embolism (r = -0.17, p = 0.2).
  
  
  CONCLUSIONS
  In order to minimize the lethal risk of gas embolization, the insufflation system has to be completely filled with CO₂ before connecting to the patient.
authors.affiliation: Department of Pediatric Surgery, University Medical Center, Mainz, Germany. steffen@richter-chirurgie.de
authors.forename: Steffen
authors.initials: S
authors.lastname: Richter
authors.forename: Christine
authors.initials: C
authors.lastname: Matthes
authors.forename: Till
authors.initials: T
authors.lastname: Ploenes
authors.forename: Devrim
authors.initials: D
authors.lastname: Aksakal
authors.forename: Tobias
authors.initials: T
authors.lastname: Wowra
authors.forename: Thomas
authors.initials: T
authors.lastname: Hückstädt
authors.forename: Felix
authors.initials: F
authors.lastname: Schier
authors.forename: Christoph
authors.initials: C
authors.lastname: Kampmann
mesh_terms: D034841:Abdominal Cavity; D000818:Animals; D049628:Body Size; D002245:Carbon Dioxide / Q000008:administration & dosage; D004195:Disease Models, Animal; D004618:Embolism, Air / Q000209:etiology*; D006439:Hemodynamics; D007327:Insufflation / Q000009:adverse effects* / Q000295:instrumentation; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy / Q000379:methods*; D007928:Lethal Dose 50; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation / Q000379:methods*; D011312:Pressure; D011897:Random Allocation; D034421:Sus scrofa; D013552:Swine
chemical_list: D002245:Carbon Dioxide