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A Comparison of the Sensitivity of Pulmonary Artery Pressure, End-Tidal Carbon Dioxide, and End-Tidal Nitrogen in the Detection of Venous Air Embolism in the Dog

Received from the Neuroanesthesia Research Laboratory, Department of Anesthesiology, University of California at San Diego, La Jolla, California and the Department of Anesthesiology, Veterans' Administration Medical Center, San Diego, California.

Abstract

The authors sought to define the relative sensitivities of endtidal carbon dioxide analysis (ET_co2), end-tidal nitrogen analysis (ETN₂), and pulmonary artery pressure (PAP) monitoring in the detection of venous air embolism (VAE). Serial injections of air (0.25, 0.5, 0.75, 1.0, arid 1.5 ml/kg) were performed in six mongrel dogs. The frequency with which positive responses (PAP increase > 2 mm Hg; ETCO₂ decrease > 0.2%; ETN₂ increase > 0.04%) were observed following VAE was not different for the three methods. The response time (time to maximum change following VAE) was significantly more rapid for PAP and ETN₂ than for ETCO₂; although the range for the three methods was narrow, e.g., for 1.5 ml/kg—PAP, 0.92 ± 0.7 (SD) min; ETN₂, 1.20 ± 0.5 min; ETCO₂, 1.85 ± 0.7 min. The time from injection of air to return to baseline levels was significantly more rapid for ETN₂ than for ETCO₂ which was in turn significantly significantly faster than PAP, e.g., for 1.5 ml/kg—ETN₂, 8.0 ± 4.3 min; ETCO₂, 19.4 ± 6.0 min; PAP, 23.8 ± 6.1 min. The results indicate that, where the capacity to identify increases in expired nitrogen on the order of 0.04% can be achieved, ETN₂ monitoring mill identify VAE events with a sensitivity similar to that of PAP and ETCO₂. However, the difficulties inherent in achieving this level of nitrogen detection sensitivity probably represent a current major limitation in the application of this method. Furthermore, the data indicate that, after VAE, ETN₂ will return to preinjection levels although PAP and ETCO₂ remain abnormal. This observation suggests that ETN₂ may not be a reliable indicator of recovery from the physiologic impact of VAE, and may therefore not be the optimum method to base decisions regarding resumption of the head-up posture and continuation of surgery during procedures in which VAE bas occurred.

Key Words: EMBOLISM—air • MONITORING—endtidal gases

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999