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CARDIOVASCULAR ANESTHESIA

Intermittent or Continuous Carbon Dioxide Insufflation for De-Airing of the Cardiothoracic Wound Cavity? An Experimental Study with a New Gas-Diffuser

Peter Svenarud, MD^*, Mikael Persson, MSc^*,, and Jan van der Linden, MD, PhD^*

*Department of Cardiothoracic Surgery & Anesthesiology, Huddinge University Hospital, Huddinge, Sweden; and Division of Medical Engineering, Department of Medical Laboratory Science & Technology, Karolinska Institute, Stockholm, Sweden

Address correspondence and reprint requests to Jan van der Linden, MD, PhD, Department of Cardiothoracic Surgery & Anesthesiology, Huddinge University Hospital, SE-141 86 Huddinge, Sweden. Address e-mail to jan.vanderlinden{at}thsurg.hs.sll.se

Insufflation of carbon dioxide into the chest wound is used in open-heart surgery to de-air the heart and great vessels. In a cardiothoracic wound model, we compared the degree of air displacement achieved by a new insufflation device, a gas-diffuser, with that of a thin open-ended tube during steady-state and with carbon dioxide flows of 2.5, 5, 7.5, and 10 L/min. We also studied air displacement at the start of and after discontinuation of carbon dioxide insufflation with the gas-diffuser and evaluated the influence of an open pleura. During steady state, the gas-diffuser produced efficient air displacement in the wound cavity model at carbon dioxide flows of 5 L/min (0.65% remaining air), whereas the open-ended tube was inefficient (82% remaining air) at all studied carbon dioxide flows (P < 0.001). An open pleural cavity prolonged the time needed to obtain a high degree of air displacement in the wound cavity (P = 0.001). Carbon dioxide insufflation of the cardiothoracic wound cavity should be initiated at a carbon dioxide flow of 10 L/min at least 1 min before the incision of the heart and great vessels and should be continued at a carbon dioxide flow of at least 5 L/min until surgical closure.

IMPLICATIONS: Carbon dioxide insufflation into a cardiothoracic wound model was studied with a new device. Efficient air removal (0.65% remaining air) required a continuous carbon dioxide flow of 5 L/min after initial filling during 1 min at 10 L/min. A conventional tube failed to provide efficient de-airing (82% remaining air).

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				M. Persson and J. van der Linden Can Wound Desiccation Be Averted During Cardiac Surgery? An Experimental Study Anesth. Analg., February 1, 2005; 100(2): 315 - 320. [Abstract] [Full Text] [PDF]

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