Efficacy Of Carbon Dioxide Insufflation Research Articles

Retained intracardiac air in cardiovascular surgery: a re-visited problem.

Intracardiac air remains an unsolved problem in the realm of cardiac surgery, leading to embolic events encompassing conduction disturbance, heart failure, and stroke. Transesophageal echocardiography allows the visualization of three distinct types of retained intracardiac air: pooled air, coarse bubbles, and microbubbles. The former two predominantly manifest in the right upper pulmonary vein, left atrium, and left ventricle, exhibiting passive movement along the vessel walls by buoyancy. De-airing, involving "eradication" of air from circulation and "expulsion" of air from the heart into the systemic circulation assumes paramount importance in averting embolic events. Optimal de-airing strategies necessitate the thorough elimination of air during the static phase before the resumption of cardiac activity, achieved through aspiration or guided exit leveraging buoyancy. While the dynamic phase, characterized by active cardiac beating, presents challenges for air eradication, the majority of air expulsion occurs towards the aorta during this period. In this latter phase, collaborative efforts among the surgeon, anesthesiologist, and clinical engineer are pivotal to mitigate the risk of bolus air embolism. The efficacy of carbon dioxide insufflation is limited, as it is rapidly aspirated by wall suction or absorbed into the bloodstream. Consequently, the "air" identified by TEE is acknowledged as conventional air. Understanding the distinctive properties of air as well as timely and judicious collaboration for detection and removal, with the ultimate goal of eradication, emerges as an essential prerequisite for successful de-airing in the evolving era of cardiac surgery.

A prospective randomized controlled trial of the safety and efficacy of carbon dioxide insufflation compared with room air insufflation during gastric endoscopic submucosal dissection.

Carbon dioxide (CO2 ) insufflation during gastric endoscopic submucosal dissection (GESD) under sedation can be used instead of room air insufflation. Appropriate monitoring of the partial pressure of CO2 during GESD is necessary due to the impaired respiration. The aim of this study was to assess the safety and efficacy of CO2 insufflation during GESD compared with conventional room air insufflation. Patients with a gastric epithelial neoplasm or early gastric cancer were enrolled. A total of 76 consecutive patients were randomly assigned to the CO2 insufflation group (CO2 group) or the room air insufflation group (air group). The primary outcome was the mean difference of end-tidal CO2 (EtCO2 ) between two groups. The upper bound of the 95% CI for the mean EtCO2 difference between the two groups before the procedure and at 15, 30 and 45 min after insufflation met the criteria for noninferiority. In a subgroup analysis of patients 70years and older, the mean difference of EtCO2 was not significantly different between two groups. However, the air group received more analgesics than the CO2 group after the procedure (67.6% vs 35.1%, P=0.005). In addition, in terms of improvement of abdominal pain or bowel gas after 24h of GESD, CO2 group showed better results than air group (both P<0.05). CO2 insufflation during GESD is as safe as using room air, and patients, including elderly patients, receiving CO2 achieve more rapid relief of abdominal pain and intra-abdominal residual gas during and after the procedure.

404 The Efficacy of Carbon Dioxide Insufflation During Consecutive Upper and Lower Gastrointestinal Endoscopy: A Randomized, Double-Blind, Controlled Prospective Study

Endoscopy is performed with using air insufflations, and is associated with abdominal discomfort. It is well recognized that carbon dioxide (CO2) is absorbed quickly in the body than air. CO2 insufflation is expected to be reduces abdominal discomfort and pain after consecutive upper and lower gastrointestinal endoscopy.

Efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection: a randomized, double-blind, controlled, prospective study

Endoscopic submucosal dissection (ESD) is commonly performed under air insufflation and is often accompanied by abdominal discomfort. CO2 is absorbed more rapidly by the body than is air; however, the use of CO2 insufflation in ESD remains controversial. This randomized, double-blind, controlled, prospective study was designed to assess the efficacy of CO2 versus air insufflation in gastric ESD. Between May 2012 and August 2014, a total of 110 patients with gastric tumors were randomly assigned to the CO2 insufflation (CO2 group, n = 54) or air insufflation group (air group, n = 56). Abdominal pain after ESD was chronologically recorded via visual analog scale (VAS) scores. Secondary outcome measurements were adverse events, abdominal circumference, amount of sedatives prescribed, and use of analgesics. Neither the baseline patient characteristics nor the mean procedural time differed between the groups. The VAS score for abdominal pain was 35.2 in the CO2 insufflation group versus 48.5 in the air insufflation group 1 hour after ESD (P = .026), 27.8 versus 42.5 three hours after ESD (P = .007), 18.4 versus 34.8 six hours after ESD (P = .001), and 9.2 versus 21.9 one day after ESD (P < .001). Changes in abdominal circumference, the amounts of sedative drugs taken, and the adverse events did not differ between the groups. However, the air insufflation group required more analgesics than did the CO2 insufflation group (CO2 group, 22.0% [11/50]; air group, 42.3% [22/52]; P = .028). CO2 insufflation during gastric ESD significantly reduced abdominal pain and analgesic usage compared with air insufflation. ( NCT01579071.)

Su1493 The Efficacy of Carbon Dioxide Insufflation in Upper Gastrointestinal Tract Endoscopic Submucosal Dissection: a Randomized, Double-Blind, Controlled Prospective Study

the large resection surface. Furthermore, a combined clip and PGA felt method may prevent postoperative complications.

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection.

To compare the safety and efficacy of carbon dioxide (CO2) and air insufflation during gastric endoscopic submucosal dissection (ESD). This study involved 116 patients who underwent gastric ESD between January and December 2009. After eliminating 29 patients who fit the exclusion criteria, 87 patients, without known pulmonary dysfunction, were randomized into the CO2 insufflation (n = 36) or air insufflation (n = 51) groups. Standard ESD was performed with a CO2 regulation unit (constant rate of 1.4 L/min) used for patients undergoing CO2 insufflation. Patients received diazepam for conscious sedation and pentazocine for analgesia. Transcutaneous CO2 tension (PtcCO2) was recorded 15 min before, during, and after ESD with insufflation. PtcCO2, the correlation between PtcCO2 and procedure time, and ESD-related complications were compared between the two groups. Arterial blood gases were analyzed after ESD in the first 30 patients (12 with CO2 and 18 with air insufflation) to assess the correlation between arterial blood CO2 partial pressure (PaCO2) and PtcCO2. There were no differences in respiratory functions, median sedative doses, or median procedure times between the groups. Similarly, there was no significant difference in post-ESD blood gas parameters, including PaCO2, between the CO2 and air groups (44.6 mmHg vs 45 mmHg). Both groups demonstrated median pH values of 7.36, and none of the patients exhibited acidemia. No significant differences were observed between the CO2 and air groups with respect to baseline PtcCO2 (39 mmHg vs 40 mmHg), peak PtcCO2 during ESD (52 mmHg vs 51 mmHg), or median PtcCO2 after ESD (50 mmHg vs 50 mmHg). There was a strong correlation between PaCO2 and PtcCO2 (r = 0.66; P < 0.001). The incidence of Mallory-Weiss tears was significantly lower with CO2 insufflation than with air insufflation (0% vs 15.6%, P = 0.013). CO2 insufflation did not cause any adverse events, such as CO2 narcosis or gas embolisms. CO2 insufflation during gastric ESD results in similar blood gas levels as air insufflation, and also reduces the incidence of Mallory-Weiss tears.

Sa1518 Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial

Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial Tesshin Ban*, Yu Nojiri, Toshihiro Ohwaki, Takashi Yoshimine, Miho Aoki, Hiroyasu Iwasaki, Yasuki Hori, Satoshi Nomura, Takaaki Kanamoto, Atsunori Kusakabe, Hiroshi Kanie, Tomonori Yamada, Katsumi Hayashi, Etsuro Orito Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan Background: Recently, Some authors reported that CO2 insufflation during ERCP made the patients feel more comfortable after their procedure than air insufflation, but one author’s findings did not agree. Objective: To investigate the efficacy of CO2 insufflation during ERCP as compared with air insufflation for reducing visual analogue scale score (VAS) after procedure. Design: Single-blind, randomized, controlled trial. Setting: Single center. Patients and Methods: From August 22nd, 2011 to July 17th, 2012. One hundred candidates were included and allocated into the CO2 group or the air group equally using the randomized number table. Main outcome measure was VAS and abdominal circumference change 3 hrs after the procedure and in the next morning. The body movement requiring extra midazolam i.v. injection during the procedure was also investigated. VAS score were from 0 to 10. Midazolam 0.1mg/kg and pentazocine 10mg were i.v. injected at the beginning of the procedure. Scopolamine Butybromide or Glucagon was used simultaneously as an antispasmodic drug. Statistics: SPSS Statistics ver.19 was used. Results: The characteristics of 49 patients and 50 patients allocated to the air group and the CO2 group were analyzed. There were no significant differences in the backgrounds between the two groups. VAS 3hrs after the procedure in the air group and the CO2 group were 0.82 1.52 and 1.19 2.02 (p 0.336), respectively. VAS next in the morning in the air group and the CO2 group were 0.38 1.54 and 0.38 1.54 (p 0.458), respectively. There were no significant differences in VAS between the two groups. The Abdominal circumference changes 3 hrs after the procedure and in the next morning in the two groups were -0.25 3.29 % vs -0.70 2.84 % (p 0.487) and -1.18 % 4.00 vs -1.31 3.03 % (p 0.861), respectively. The rates of body movement requiring extra midazolam i.v. injections during the procedure were 27.7% and 38.0% (p 0.279), respectively. There were no differences between the two groups. Conclusion: Our results did not support the efficacy of carbon dioxide insufflation during ERCP for relieving abdominal pain after the procedure.

Efficacy of Carbon Dioxide Insufflation for Cerebral and Cardiac Protection During Open Heart Surgery: A Systematic Review and Meta‐Analysis

In spite of widespread application around the world, there has been controversy on the cerebral and cardiac protection efficacy of carbon dioxide insufflation (CDI) during open heart surgery. To make a comprehensive evaluation, we screened all relevant published randomized controlled trials to perform the first systematic review and meta-analysis for CDI during open heart surgery. We searched PubMed, EMBASE, the Cochrane Controlled Clinical Trial register, WANFAN, CQVIP, and CNKI database for published articles. Randomized controlled trials were included when the research provided data of neurological complications postoperatively, creatinine kinase, MB isoenzyme (CK-MB) on the first postoperative day, or all-cause mortality. We chose a fixed-effects model when the trials showed low heterogeneity, otherwise a random effects model was used. The quality of studies was assessed by modified Jadad scale. Four studies were included in this meta-analysis. The overall pooled relative risk (RR) for neurological complications was 1.59, 95% confidence interval (CI) = [0.57, 4.46], and the z-score for overall effect was 0.89 (P = 0.37). The standardized mean difference of the CK-MB between groups was 1.15, 95% CI = [-1.27, 3.56], and the z-score for overall effect was 0.93 (P = 0.35). The overall pooled RR for all-cause mortality was 0.5, 95% CI = [0.16, 1.64], and the z-score for overall effect was 1.14 (P = 0.25). There was no significant difference between groups. Because of the insufficiency of powerful evidences, the cerebral and cardiac protection efficacy of CDI during open heart surgery needs to be further verified by more high-quality trials.

A prospective, randomized, double-blind, controlled trial on the efficacy of carbon dioxide insufflation in gastric endoscopic submucosal dissection

Carbon dioxide (CO2) insufflation is expected to be safe and effective in endoscopic submucosal dissection (ESD) as well as in other endoscopic procedures. The present study aimed to clarify the usefulness and safety of CO2 insufflation in gastric ESD. A total of 102 consecutive patients were randomly assigned to CO2 insufflation (CO2 group, n = 54) or air insufflation (Air group, n = 48). Abdominal pain and distension were chronologically recorded on a 100-mm visual analog scale (VAS). The volume of residual gas in the digestive tract was measured by computed tomography performed immediately after ESD. Abdominal pain on a 100-mm VAS in the CO2 vs. Air group was 4 vs. 3 immediately after ESD, 4 vs. 4 one hour after the procedure, 3 vs. 3 three hours after the procedure, and 1 vs. 4 the next morning, showing no difference between the groups. In addition, there was no difference in abdominal distension on the 100-mm VAS over the time course of the study. The volume of residual gas in the digestive tract in the CO2 group was significantly smaller than that in the Air group (643 mL vs. 1037 mL, P < 0.001). The dose of sedative drugs did not differ between the groups. Neither the incidences of complications nor clinical courses differed between the groups. Compared with air insufflation, CO2 insufflation during gastric ESD significantly reduced the volume of residual gas in the digestive tract but not the VAS score of abdominal pain and distension.

Sa1603 A Pilot Study to Assess the Safety and Efficacy of Carbon Dioxide Insufflation in Sedated Pediatric Endoscopy

Several studies have shown that insufflation of carbon dioxide(CO2) instead of air during endoscopy can reduce postprocedual abdominal distension in adult. However, CO2 insufflation might also lead to CO2 retention in the human body especially in sedated patients and children.

W1057 Safety and Efficacy of Carbon Dioxide Insufflation During Endoscopic Submucosal Dissection of Large Polyps and Early Cancers of the GI Tract: A Retrospective Analysis

W1057 Safety and Efficacy of Carbon Dioxide Insufflation During Endoscopic Submucosal Dissection of Large Polyps and Early Cancers of the GI Tract: A Retrospective Analysis

Efficacy of carbon dioxide insufflation in endoscopic balloon dilation therapy by using double balloon endoscopy

Efficacy of carbon dioxide insufflation in endoscopic balloon dilation therapy by using double balloon endoscopy

A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation

Endoscopic submucosal dissection (ESD) is accepted as one of the treatments for en bloc resection of large superficial colorectal lesions. This procedure is performed by using air insufflation, is time consuming, and is associated with severe abdominal discomfort. The safety and efficacy of carbon dioxide (CO(2)) insufflation during colonoscopy already has been assessed in some trials. To assess the safety and efficacy of CO(2) insufflation instead of air insufflation during colorectal ESD with the patient under conscious sedation. A case-control series with a historical control. A total of 35 consecutive patients were enrolled in this study. Another 35 consecutive patients who previously received colorectal ESDs by using air insufflation were included as a historical control. Arterial partial pressure of CO(2) (pCO(2)) was measured before and after each procedure with the total dose of midazolam used as an index of abdominal discomfort. The mean (standard deviation [SD]) operation time was 90 +/- 57 minutes in the CO(2) group and 100 +/- 80 minutes in the control group (not significant). In the CO(2) group, the mean (SD) dose of midazolam was significantly lower than that of the control group; 5.6 +/- 4.9 mg and 9.7 +/- 5.9 mg, respectively (P = .005). Blood analysis revealed a slight pCO(2) elevation in the CO(2) group; however, only 2 patients complained of mild abdominal discomfort. Abdominal discomfort and pCO(2) were not evaluated in the control group. This study strongly suggests that CO(2) insufflation is safe and effective during lengthy colonic endoscopic procedures, eg, ESD, with the patient under conscious sedation.

A Pilot Trial Study to Assess Safety and Efficacy of Carbon Dioxide Insufflation During Colorectal Endoscopic Submucosal Dissection

Introduction: In colonoscopy, carbon dioxide (CO2) insufflation is safe and effective in reducing patient discomfort, but air insufflation is still the standard method and there are no reports about its use during lengthy colonoscopic procedures. Some colonoscopists have performed endoscopic submucosal dissection (ESD) of large superficial colorectal lesions using air insuflation, but this usually causes severe abdominal discomfort. In addition, perforations, subcutaneous emphysema and pneumothorax have been reported in colorectal ESDs.

Norwegian colorectal cancer prevention (NORCCAP): A randomized controlled trial to assess the safety and efficacy of carbon dioxide insufflation in colonoscopy

Norwegian colorectal cancer prevention (NORCCAP): A randomized controlled trial to assess the safety and efficacy of carbon dioxide insufflation in colonoscopy