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Letters to the Editor

The need for monitoring during endovascular vein harvesting

Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

Received 27 September 2007; accepted 10 October 2007.

^_* Corresponding author. Tel.: +91 9446177523; fax: +91 471 2446433. (Email: pksinha02{at}yahoo.com).

Key Words: Endoscopic vein harvest • Capnography • Transesophageal echocardiography

We read with great interest the description of carbon dioxide embolism during endoscopic saphenous vein harvest reported by Potapov et al. [1]. It is well known that the procedure can cause hypercarbia [2] and there have been previous descriptions of carbon dioxide embolism [3] as well. The authors seem to have used transesophageal echocardiography (TEE) after the event but not during the acute crisis. They also do not mention whether or not end tidal carbon dioxide (ETCO₂) monitoring was in place. Both of these modalities have been shown to enhance the diagnostic dilemmas of acute cardiovascular collapse in this setting [3,4]. A sudden decline in the ETCO₂ could have been a warning for the impending hemodynamic event. Alternatively, TEE would have demonstrated the presence of gas in the right atrium and more specifically the inferior vena cava demonstrating the infra-diaphragmatic origin of the embolus. In the absence of either of these monitoring modalities, we feel that endoscopic vein harvest with carbon dioxide insufflation is unsafe. While the authors need to be commended for the successful outcome, it is possible that the institution of cardiopulmonary bypass might not always be prompt, and, that other options such as the use of pulmonary vasodilators also merit consideration. We strongly recommend inclusion of TEE and ETCO₂ in patient's monitoring especially in this setting for the safe conduct of the procedure.

References

1. Potapov EV, Buz S, Hetzer R. CO(2) embolism during minimally invasive vein harvesting. Eur J Cardiothorac Surg 2007;31:944-945.[Abstract/Free Full Text]
2. Leissner KB, Woo A, Ortega R, Stanley GD. Endoscopic saphenous vein harvest: severe hypercarbia. J Cardiothorac Vasc Anesth 2006;20:759-760.[CrossRef][Medline]
3. Martineau A, Arcand G, Couture P, Babin D, Perreault LP, Denault A. Transesophageal echocardiographic diagnosis of carbon dioxide embolism during minimally invasive saphenous vein harvesting and treatment with inhaled epoprostenol. Anesth Analg 2003;96:962-964.[Abstract/Free Full Text]
4. Joris JL. Anesthesia for laparoscopic surgery. In: Miller RD, editor. Miller's Anesthesia. New York, NY: Elsevier Churchill Livingstone; 2005. pp. 2285-2306.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sinha, P. K. Articles by Kumar, B. Search for Related Content PubMed PubMed Citation Articles by Sinha, P. K. Articles by Kumar, B. Related Collections Anesthesia Extracorporeal circulation Peripheral vascular