Severe Hypercapnia during Cardiopulmonary Bypass due to Carbon Dioxide Insufflation - A case report -

Abstract

Air embolization is a potential danger during open heart surgery. To prevent air embolization in incompletely deaired cardiac chambers, flooding of the surgical fields with carbon dioxide (CO2) is used during cardiopulmonary bypass. CO2 flooding may be more useful in de-airing for patients undergoing minimally invasive cardiac surgery. We experienced an episode of sudden, severe hypercapnia and respiratory acidosis in a 51-year-old female patient during hypothermic cardiopulmonary bypass for minimally invasive mitral valve replacement. During hypercapnia, hemodynamic and BIS data were stable except for a slight increase in mean arterial pressure. After ruling out other causes of hypercapnia such as oxygenator failure and malignant hyperthermia, severe hypercapnia disappeared gradually after the cessation of CO2 flooding in the surgical field. No neurologic or cardiopulmonary complications were noted after the operation. We concluded that frequent or continuous CO2 monitoring may be required during CO2 insufflation at surgical fields to prevent hypercapnic complications in minimally invasive cardiac surgery. (Korean J Anesthesiol 2008; 54: 94∼7)