Clinical Research Papers:
Randomized clinical trial comparing the effects of sevoflurane and propofol on carbon dioxide embolism during pneumoperitoneum in laparoscopic hepatectomy
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Yu Hong1, Yu Xin2, Fei Yue2, He Qi3 and Cai Jun1
1 Department of General Surgery, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China
2 Department of Anesthesia, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang, China
3 Lincoln Christian School, Lincoln, NE, USA
Cai Jun, email:
Keywords: anesthetics, carbon dioxide embolism, laparoscopic hepatectomy, transesophageal echocardiography
Received: August 29, 2016 Accepted: February 06, 2017 Published: February 18, 2017
Laparoscopic hepatectomy carries a high risk of gas embolism due to the extensive hepatic transection plane and large hepatic vena cava. Here, we compared the influence of inhaled and intravenous anesthetics on gas embolism during laparoscopic hepatectomy. Fifty patients undergoing laparoscopic hepatectomy were divided into two groups to receive sevoflurane anesthesia (group S, n = 25) or intravenous propofol anesthesia (group p, n = 25). During the operation, gas emboli were detected by transesophageal echocardiography and graded according to their size. Venous CO2 emboli were detected in all patients, and the embolism grades did not differ between the two groups. However, the mean embolism episode duration was longer in group S than group P (51.24±23.59 vs. 34.00±17.13 sec, p < 0.05). At the point of the most severe gas embolism, the PTCO2 was higher in group S than group p (44.00±4.47 vs. 41.36±2.77 mmHg, p < 0.05), while the PO2/FiO2 (450.52±54.08 vs. 503.80±63.18, p < 0.05) and pH values (7.35±0.05 vs. 7.38±0.02, p < 0.05) were lower in group S than group P. Patients with a history of abdominal surgery or liver cirrhosis had higher gas embolism grades. Thus volatile anesthetics may lengthen the duration of embolism episodes and worsen hemodynamics and pulmonary blood gas exchange during surgery.
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