title: Systemic effects of carbon dioxide insufflation technique for de-airing in left-sided cardiac surgery.
abstract: OBJECTIVE
  Systemic effects of carbon dioxide (CO2) insufflation during left-sided cardiac surgery were evaluated in a prospective randomized study, with regard to acid-base status, gas exchange, cerebral hemodynamics, and red blood cell morphology.
  
  
  METHODS
  Twenty patients undergoing elective left-sided cardiac surgery were randomized to de-airing procedure either by CO2 insufflation technique (CO2 group, n = 10) or by Lund technique without CO2 insufflation (Lund group, n = 10). Groups underwent assessment of acid-base status by intermittent arterial blood gases and in-line blood gas monitoring. Capnography was used to determine volume of CO2 produced. Cerebral hemodynamics was measured by transcranial Doppler sonography and near-infrared spectroscopy. Red cell morphology from cardiotomy suction and vent tubing was studied by scanning electron microscopy.
  
  
  RESULTS
  Patients in the CO2 group consequently developed significantly higher levels of hypercapnia with a concomitant increase in the volume of CO2 produced despite significantly higher oxygenator gas flows compared with the Lund group. Effects on cerebral hemodynamics were observed in the CO2 group with significantly higher blood flow velocities in the middle cerebral artery and higher regional cerebral saturation. Red blood cell damage was observed in the CO2 group by scanning electron microscopy (97% in CO2 group vs 18% in Lund group).
  
  
  CONCLUSIONS
  Insufflation of CO2 into the cardiothoracic wound cavity during left-sided cardiac surgery can induce hypercapnic acidosis and increased cerebral blood flow and local blood cell damage. These systemic effects should be monitored by in-line capnography and acid-base measurements for early and effective correction by increase in gas flows to the oxygenator.
authors.affiliation: Department of Cardiothoracic Surgery, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden. Electronic address: maya.landenhed@med.lu.se.
authors.forename: Maya
authors.initials: M
authors.lastname: Landenhed
authors.affiliation: Department of Cardiothoracic Surgery, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Faleh
authors.initials: F
authors.lastname: Al-Rashidi
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Sten
authors.initials: S
authors.lastname: Blomquist
authors.affiliation: Clinical Research and Competence Center, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.affiliation: Department of Cardiothoracic Surgery, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Pierre
authors.affiliation: Department of Cardiothoracic Surgery, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Bansi
authors.initials: B
authors.lastname: Koul
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects; D000138:Acidosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D000368:Aged; D001784:Blood Gas Analysis; D019296:Capnography; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D017558:Elective Surgical Procedures; D004912:Erythrocytes / Q000187:drug effects / Q000648:ultrastructure; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000187:drug effects / Q000503:physiopathology; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D019265:Spectroscopy, Near-Infrared; D013548:Sweden; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D002245:Carbon Dioxide