Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.
Carbon Dioxide/*adverse effects ; Embolism, Air/*diagnosis/epidemiology/prevention & control/surgery ; Humans ; Insufflation/adverse effects ; Laparoscopy/*adverse effects

INTRODUCTION: Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. METHODS: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO₂), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO₂), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared. RESULTS: The values of ETCO₂, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO₂ at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar. CONCLUSION During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.
Humans ; Laryngeal Masks ; Carbon Dioxide ; Retrospective Studies ; Intubation, Intratracheal ; Laparoscopy/adverse effects* ; Postoperative Complications/etiology* ; Oxygen

In this study, we investigated the effect of different values of intra-abdominal pressure on bacterial translocation. Twenty-four Wistar-Albino rats were divided into four groups. The animals belonging to the Control group were not subjected to any increased intra-abdominal pressure. In groups I, II and III, an intra-abdominal pressure of 14, 20, and 25 mmHg, respectively, was established by carbon dioxide pneumoperitoneum for a period of 60 minutes. Four hours after the pneumoperitoneum, all animals were sacrificed to evaluate the degree of bacterial translocation at this time. Liver, spleen and mesenteric lymph nodes were excised under sterile conditions. Bacterial growth was assessed using standard bacteriological techniques and compared statistically. The Kruskal-Wallis and Mann-Whitney U tests were used for the statistical analysis. Different amounts of bacterial growth were found in all of the animals subjected to increased intra-abdominal pressure, except for the controls. Bacterial translocation was detected at an intra-abdominal pressure of 14 mmHg but this finding was not statistically significant (p > 0.05). There was a significant increase in bacterial growth in animals subjected to an intra- abdominal pressure of 20 mmHg or above (p < 0.001). As a result, we found that bacterial translocation started when the intra-abdominal pressure reached a level of 14 mmHg. Patients should be closely monitored for septic complication risks following laparoscopic procedures in which the intra-abdominal pressure exceeds 20 mmHg.
Abdomen ; Animals ; *Bacterial Translocation ; Carbon Dioxide ; Laparoscopy/*adverse effects ; Pneumoperitoneum, Artificial/adverse effects ; Pressure ; Rats ; Rats, Wistar ; Splanchnic Circulation

Carbon Dioxide ; Cardiopulmonary Resuscitation ; Echocardiography, Transesophageal ; Embolism, Air ; etiology ; therapy ; Female ; Humans ; Laparoscopy ; adverse effects ; Middle Aged ; Nephrectomy ; adverse effects

BACKGROUNDThe ability of pneumoperitoneum in laparoscopic surgery to promote proliferation and metastasis of colorectal cancer has become a focus of research in the field of minimally invasive surgery. The aim of this research was to investigate the effect of CO2 pneumoperitoneum under different pressures and exposed times on the expression of chemokine receptors in colorectal carcinoma cells.

METHODSWe constructed an in vitro pneumoperitoneum model. SW480 colon carcinoma cells were exposed to CO2 pneumoperitoneum under different pressures (6, 9, 12, and 15 mmHg) for 1, 2, and 4 hours. These cells were then cultivated under the same conditions as normal SW480 colon carcinoma cells without CO2 pneumoperitoneum (control group), treated at 37°C, and 5% CO2. The expression of the chemokine receptors CXC receptor 4 (CXCR4) and chemokine C receptor 7 (CCR7) was detected by immunocytochemistry and reverse transcriptase polymerase chain reaction after being cultivated for 0, 24, 48, and 72 hours.

RESULTSImmunocytochemistry showed that CXCR4 expression in SW480 cells was significantly decreased in the 6, 9, 12, and 15 mmHg CO2 pneumoperitoneum-treated groups for the same exposure times compared with controls (P < 0.05). CCR7 expression in SW480 cells was significantly decreased in the 12 and 15 mmHg CO2 pneumoperitoneum-treated groups compared with controls (P < 0.05). CXCR4 and CCR7 expression increased up to the level of the control group after 24 and 48 hours (P > 0.05). If the CO2 pneumoperitoneum pressure increased, CXCR4 and CCR7 expression decreased at all exposure times. If the CO2 pneumoperitoneum exposure time prolonged, there were no significant differences in CXCR4 and CCR7 expression under the same pressure. Under all exposure times, CXCR4 and CCR7 mRNA expression was significantly decreased in the 6, 9, 12, and 15 mmHg CO2 pneumoperitoneum-treated groups (P < 0.05) compared with controls, and it increased up to the level of controls after being cultivated for 48 hours (P > 0.05). If the CO2 pneumoperitoneum pressure increased (with all exposure times) and exposure time prolonged (under the same pressure), there were no significant differences in CXCR4 and CCR7 expression.

CONCLUSIONSCXCR4 and CCR7 expression is temporarily affected after continuous CO2 pneumoperitoneum treatment. The high pressure of CO2 pneumoperitoneum plays an important role in suppressing the expression of these chemokine receptors. Different lengths of time of exposure to a CO2 pneumoperitoneum-like environment do not change CXCR4 and CCR7 expression.

Carbon Dioxide ; adverse effects ; Cell Line, Tumor ; Colorectal Neoplasms ; metabolism ; Humans ; Receptors, CCR7 ; metabolism ; Receptors, CXCR4 ; metabolism ; Retropneumoperitoneum ; complications ; metabolism

OBJECTIVE: To explore the influence of carbon dioxide pneumoperitoneum-laparoscopic surgery on tumor cell seeding and metastases in endometrial cancer. METHODS: Twenty patients with endometrial cancer who underwent laparoscopic surgery and 10 patients with endometrial cancer who underwent laparotomic surgery were enrolled. Each patient was in preoperative clinical StageIand the uterus size in each patient was less than 12 weeks of pregnancy. Carbon dioxide pneumoperitoneum was established and maintained with CO2 insufflation at 4 approximately 6 L/min and intraperitoneal pressure of 13 mmHg with an automatic pneumoperitoneum machine. Cytologic examination of peritoneal fluid(at the beginning and end of the operation), CO2 filtrated gas and the lavage fluid of instruments during the laparoscopic surgery were performed. The protein expressions of E-cadherin,beta-catenin,P-selectin,matrix metalloproteinase-2(MMP-2),vascular endothelial growth factor (VEGF),and CD44v6 in tumor tissues before and after the operation were detected by DAKO Envision. RESULTS: There were no case of positive washing cytology in the peritoneal fluid,CO2 filtrated gas, and the lavage fluid of instruments during the laparoscopic surgery. The expressions of E-cadherin and beta-catenin proteins were obviously abnormal in endometrial cancer. The abnormal expressions of E-cadherin and beta-catenin protein between the pre- and post-operations were not significantly different in both the laparoscopic group and the laparotomic group(P>0.05).The changes of abnormal expressions of E-cadherin and beta-catenin protein were no statistical difference between the two groups(P>0.05). The positive protein expressions of P-selectin,MMP-2,VEGF,and CD44v6 were not significantly different between the pre- and post-operations both in the laparoscopic group and the laparotomic group(P>0.05),and there was also no significant difference between the laparoscopic group and the laparotomic group(P>0.05).The follow-up period in the laparoscopic group was 7 approximately 19 (14.25+/-3.65) months and 7 approximately 19 (13.10+/-4.23) months in the laparotomic group. One patient got infection in the urinary system in the laparoscopic group and one patient had lower extremity venous thrombosis in the laparoscopic group.No recurrence was detected in both groups. CONCLUSION Laparoscopic surgery for endometrial cancer has no effect on protein expressions of E-cadherin,beta-catenin,P-selectin,MMP-2,VEGF,and CD44v6 in tumor tissues. No evidence has been found that CO2 pneumoperitoneum-laparoscopic surgery may favor endometrial cancer cell seeding and metastases.
Adult ; Carbon Dioxide ; Carcinoma, Endometrioid ; surgery ; Endometrial Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; adverse effects ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Seeding ; Pneumoperitoneum, Artificial ; adverse effects

Carbon Dioxide ; adverse effects ; Coronary Artery Bypass ; adverse effects ; Embolism, Air ; complications ; Endoscopy ; Humans ; Male ; Middle Aged ; Saphenous Vein ; transplantation ; Shock ; etiology

Carbon Dioxide ; Dental Enamel ; injuries ; Dental Pulp ; injuries ; Dentin ; injuries ; Erbium ; Hot Temperature ; Humans ; Laser Therapy ; adverse effects ; Lasers ; Lasers, Solid-State ; Neodymium ; Tooth ; radiation effects

OBJECTIVE: To assess the safety and efficacy of carbon dioxide (CO(2)) in colonoscopy examination. METHODS: We randomized 349 patients to undergo colonoscopy with insufflation of air (n=175) or CO(2) (n=174). At colonoscopy, p (ET CO(2)) was observed at 4 time points: before the exam, arrived caecum, back rectum, and after the exam. Patient's experience of pain in the end and after the examination at 1, 3, 6, and 24 h was registered using a visual analog scale (VAS). Sedation was not used routinely. RESULTS: The groups were similar in age, sex, inspection time, and caecal intubation rate (all P>0.05). There were no significant differences in p (ET CO(2)) values between the 2 groups before and after the procedure (all P>0.05). VAS scores in the CO(2) group at various time points after the examination were significantly lower than those in the air group (all P<0.05). The percent of VAS scores of 0 in the CO(2) group after 1, 3, 6, and 24 h was significantly higher than that in the air group (all P<0.01). CONCLUSION Injection of CO(2) for colonoscopy will not cause CO(2) retention, and it may significantly reduce the pain, which is safe and effective.
Abdominal Pain ; prevention & control ; Adult ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Colonoscopy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Safety

OBJECTIVE: To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults. METHODS: This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results. RESULTS: The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m². During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m³, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m³, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m³ increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m³. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter. CONCLUSION Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.
Humans ; Female ; Adult ; Young Adult ; Air Pollutants/analysis* ; Heart Rate/physiology* ; Volatile Organic Compounds/analysis* ; Carbon Dioxide ; Particulate Matter/adverse effects* ; Environmental Pollutants