Cardiovascular collapse caused by carbon dioxide insufflation during one-lung anaesthesia for thoracoscopic dorsal sympathectomy

Publisher's copy made available with the permission of the publisherCarbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas. Possible mechanisms for the cardiovascular collapse are discussed, and the role of carbon dioxide insufflation as a means of expediting lung collapse for procedures performed using single-lung ventilation is questioned.RJD Harris, G Benveniste, J Pfitznerhttp://www.aaic.net.au/Article.asp?D=200119

The effect of alcohol on pancreatic blood flow: an experimental study.

The reference sample method using 15 micron diameter radionuclide labelled carbon microspheres was used to establish a rat model of pancreatic blood flow which was then used to follow up previously reported studies in dogs which showed that intravenously administered alcohol lead to a fall in pancreatic blood flow. In addition, the oral administration of alcohol alone and in combination with glucose was studied. The literature regarding pancreatic blood flow was reviewed with special emphasis on techniques of measurement and the effect of intravenously administered alcohol. While the rat model proved highly successful, it was not possible to use a dual injection technique as had been previously carried out in the larger experimental animal. This meant that instead of carrying out a control measurement on each animal it was necessary to have separate control and experiment groups. The major findings of the study were of difference in pancreatic blood flow between fasted (105 ± 9, mean ± s.e.) and non-fasted animals (134 ± 11) which was significant at the 0.025 level using the unpaired t test (t=2.14, df 18, p<0.025). No significant changes in pancreatic blood flow were observed with alcohol administered via intravenous or via gastric infusion compared to control groups. The major finding of the study was that a combination of alcohol and glucose administered via gastric infusion was found to produce a rise in pancreatic blood flow (161 ± 19) which was greater than that seen with either intravenous alcohol alone (111 ± 9) or glucose alone (90 ± 6). This change was highly significant (t=2.70, df 10, p<0.0125). It is concluded that the rat is a suitable experimental model for studying pancreatic blood flow with the microsphere method, that fasting significantly lowers pancreatic blood flow, and that the combination of alcohol and glucose is a potent stimulator of pancreatic blood flow.Thesis (M.S.) -- University of Adelaide, School of Medicine, 201

Multiple pancreaticoduodenal artery aneurysms with a primary duodenal fistula

Domenic R. Robinson, Peter S. Subramaniam, Martin Bruening and Glen L. Benvenist