Hemodynamic effects of carbon dioxide insufflation during endoscopic vein harvesting

Background . A prospective study was performed assessing the hemodynamic effects of carbon dioxide (CO 2 ) insufflation during endoscopic vein harvesting (EVH) using the Guidant Vasoview Uniport system. Methods . Five hemodynamic and respiratory parameters (end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, mean arterial pressure, mean pulmonary arterial pressure, and cardiac output), were measured in 100 consecutive patients undergoing EVH with CO 2 insufflation. Data were obtained prior to commencement of EVH, 15 minutes after commencement, and 5 minutes after completion of the vein harvesting. Results . No adverse hemodynamic effects were observed during CO 2 insufflation. Specifically, average mean arterial pressure went from 88.77 ± 9.64 to 89.13 ± 8.60 to 88.24 ± 8.71 mm Hg before, during, and after endoscopic vein harvesting ( p = 0.291). Likewise, average mean pulmonary artery pressures were 19.76 ± 4.75, 20.05 ± 4.48, and 20.05 ± 4.62 mm Hg ( p = 0.547); and average cardiac output was 4.25 ± 0.74, 4.22 ± 0.73, and 4.23 ± 0.69 L/min ( p = 0.109) at those three intervals. Additionally, there was no evidence of significant systemic absorption of CO 2 as reflected in average arterial Pco 2 , which remained steady at 37.42 ± 5.19, 37.51 ± 4.59, and 38.10 ± 4.80 mm Hg ( p = 0.217); and average end-tidal CO 2 , which was 32.10 ± 3.66, 32.50 ± 3.47, and 32.38 ± 3.33 mm Hg ( p = 0.335). In a subset of 20 patients with elevated pulmonary arterial pressure (more than 32 mm Hg), there was also no significant change in any of the parameters. Conclusions . Carbon dioxide insufflation during EVH leads to no adverse hemodynamic consequences or systemic CO 2 absorption. The technique appears to be safe and well tolerated.