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Which is the optimal device for carbon dioxide de-airing of the cardiothoracic wound and how should it be positioned?: 055

van der Linden, J.; Persson, M.; Svenarud, P.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 12

Introduction: Carbon dioxide (CO2) insufflation into the cardiothoracic wound is used in cardiac surgery in order to improve de-airing of the heart and great vessels. The objective of this study was to compare the de-airing efficiency of various insufflation devices.

Method: De-airing was assessed by measuring the remaining air content (O2-analysis) at the right atrium in a full-size torso with a cardiothoracic wound cavity and in 10 patients undergoing cardiac surgery. CO2 was insufflated into the wound cavity model at 2.5, 5, 7.5, and 10 L min−1 with a multiperforated catheter, and a 2.5 mm tube with either a gauze sponge or a gas-diffuser of polyurethane foam at its end. The devices were tested when positioned at the level of the wound opening and 5cm below, and after exposure to fluid.

Results: With the multi-perforated catheter, the gauze sponge, and the gas-diffuser, the lowest median air content in the torso was 8.4%, 2.5%, and 0.3%, respectively (P < 0.001, Wilcoxon's test), when positioned inside the wound cavity. When exposed to fluid, the gauze sponge and the multiperforated catheter immediately became inefficient (70% and 96% air, respectively), whereas the gas-diffuser remained efficient (0.4% air). During surgery the gas-diffuser provided a median air content of 1.0% at 5 L min−1, and 0.7% at 10Lmin−1.

Conclusions: For efficient de-airing, CO2 has to be delivered from within the wound cavity. The gas-diffuser was the most efficient device. In contrast to a gas-diffuser, a multi-perforated catheter or a gauze sponge is unsuitable for CO2 de-airing since they will stop functioning when they get wet in the wound.

References:

1 Svenarud P, Persson M, van der Linden J. Intermittent or continuous carbon dioxide insufflation for de-airing of the cardiothoracic wound cavity? An experimental study with a new gas-diffuser. Anesth Analg 2003; 96: 321-327.
2 Persson M, van der Linden J. De-airing of a cardiothoracic wound cavity model with carbon dioxide: theory and comparison of a gas diffuser with conventional tubes. J Cardiothorac Vasc Anesth 2003; 17: 329-335.
3 Svenarud P, Persson M, van der Linden J. The effect of CO2 insufflation on the number and behaviour of air microemboli in open-heart surgery. Circulation (accepted for publication).
    © 2004 European Society of Anaesthesiology