Change search
ReferencesLink to record
Permanent link

Direct link
Elevated PEEP without effect upon gas embolism frequency or severity in experimental laparoscopic liver resection
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
2012 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 109, no 2, 272-278 p.Article in journal (Refereed) Published
Abstract [en]

Carbon dioxide (CO2) embolism is a potential complication in laparoscopic liver surgery. Gas embolism (GE) is thought to occur when central venous pressure (CVP) is lower than the intra-abdominal pressure (IAP). This study aimed to investigate whether an increased CVP due to induction of PEEP could influence the frequency and severity of GE during laparoscopic liver resection. Twenty anaesthetized piglets underwent laparoscopic left liver lobe resection and were randomly assigned to either 5 or 15 cm H2O PEEP (n10 per group). During resection, a standardized injury to the left hepatic vein [venous cut (VC)] was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored, and online arterial blood gas monitoring and transoesophageal echocardiography (TOE) were used. The occurrence and severity of embolism was graded as 0 (none), 1 (minor), or 2 (major), depending on the TOE results. No differences were found between the two groups regarding the frequency or severity of GE, during either the VC (P0.65) or the rest of the surgery (P0.24). GE occurred irrespective of the CVPIAP gradient. Mechanisms other than the CVPIAP gradient seemed during laparoscopic liver surgery to contribute to the formation of CO2 embolism. This is of clinical importance to the anaesthetists.

Place, publisher, year, edition, pages
2012. Vol. 109, no 2, 272-278 p.
Keyword [en]
CVP gradient, gas embolism, laparoscopic, liver surgery, PEEP
National Category
Clinical Medicine
URN: urn:nbn:se:uu:diva-171302DOI: 10.1093/bja/aes129ISI: 000306363900022OAI: diva2:512909
Available from: 2012-03-29 Created: 2012-03-16 Last updated: 2012-08-07Bibliographically approved
In thesis
1. Gas Embolism in Laparoscopic Liver Surgery
Open this publication in new window or tab >>Gas Embolism in Laparoscopic Liver Surgery
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Laparoscopic liver surgery is complicated due to the structure of this organ with open sinusoids. A serious disadvantage is the risk of gas embolism (GE) due to CO2 pneumoperitoneum. CO2 can enter the vascular system through a wounded vein. A common opinion is that gas fluxes along a pressure gradient, e.g. CVP-intra abdominal pressure (IAP). The occurrence of GE could also be eased by entrainment, a ‘Venturi-like’ effect, due to cyclic differences in thoracic pressure and blood flow caused by mechanical ventilation at normal frequency.

The aims of these studies were to survey, in a porcine model, the influence on respiratory and haemodynamic variables by GE, to determine at what frequency, severity and duration GE occurs during laparoscopic liver resection (LLR) and whether there are methods to influence the occurrence or severity of GE.

Pulmonary and circulatory variables were monitored and measured as well as continuous blood gas monitoring. Transoesophageal echocardiogram was used to identify GE and, according to the amount of bubbles in the right outflow tract of the heart, GE was graded as 0, 1 and 2. Pneumoperitoneum was created by using CO2and IAP was set to 16 mm Hg.

A single bolus dose of CO2 influenced respiratory and haemodynamic variables for at least 4 h. During LLR GE occurred in 65-70% of the animals, of which the more serious caused negative influence on cardiopulmonary variables.

Elevated PEEP (15 cm H2O) increased CVP but GE occurred irrespective if CVP was lower than or exceeded IAP. In two last studies, a hepatic vein was cut and left open for 3 m before it was clipped. Interestingly, no signs of GE were seen despite an open vein and IAP > CVP in 8 of 20 animals. In the last study high frequency jet ventilation was used in order to minimise the risk of entrainment. The duration of GE was shortened.

The occurrence of GE seemed to be influenced by several different factors. The physiological reaction of a GE is impossible to predict for a specific patient, and depends among other factors on comorbidity, and amount, site and entrance rate of GE.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 49 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 758
Gas embolism, laparoscopic liver, CVP, PEEP, high frequency jet ventilation, cardiopulmonary physiology, carbon dioxide
National Category
Basic Medicine
Research subject
Anaesthesiology and Intensive Care
urn:nbn:se:uu:diva-171797 (URN)978-91-554-8325-8 (ISBN)
Public defence
2012-05-11, Enghoffsalen, Akademiska Sjukhuset, Uppsala, 09:00 (English)
Available from: 2012-04-20 Created: 2012-03-27 Last updated: 2012-08-01Bibliographically approved

Open Access in DiVA

fulltext(324 kB)178 downloads
File information
File name FULLTEXT04.pdfFile size 324 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Fors, DiddiEiriksson, KristinnArvidsson, DagRubertsson, Sten
By organisation
Anaesthesiology and Intensive CareUpper Abdominal Surgery
In the same journal
British Journal of Anaesthesia
Clinical Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 178 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 358 hits
ReferencesLink to record
Permanent link

Direct link