CO(2) artificial pneumothorax on coagulation and fibrinolysis during thoracoscopic esophagectomy

BACKGROUND: CO(2) artificial pneumothorax creates a sufficient operative field for thoracoscopic esophagectomy. However, it has potential complications and continuous CO(2) insufflation may impede coagulation and fibrinolysis. We sought to compare the effects of CO(2) artificial pneumothorax on perioperative coagulation and fibrinolysis during thoracoscopic esophagectomy. METHODS: We investigated patients who underwent thoracoscopic esophagectomy with (group P, n = 24) or without CO(2) artificial pneumothorax (group N, n = 24). The following parameters of coagulation–fibrinolysis function: intraoperative bleeding volume; serum levels of tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thromboelastogram (TEG), D-Dimer; and arterial blood gas levels were compared with two groups. RESULTS: Group P showed higher levels of PaCO(2), reaction time (R) value and kinetics (K) value, but significantly lower pH value, alpha (α) angle and Maximum Amplitude (MA) value at 60 minutes after the initiation of CO(2) artificial pneumothorax than group N ((P < .05, all). The t-PA level after CO(2) insufflation for 60 minutes was significantly higher in group P than in group N (P < .05), but preoperative levels were gradually restored on cessation of CO(2) insufflation for 30 min (P > .05). There was no significant difference in D-dimer. CONCLUSION: CO(2) artificial pneumothorax during thoracoscopic esophagectomy had a substantial impact on coagulation and fibrinolysis, inducing significant derangements in pH and PaCO(2). TRIAL REGISTRATION: The study was registered at the Chinese clinical trial registry (ChiCTR1800019004)