Management of Poor Tidal Volumes During Argon-Beam Coagulator Use in Laparoscopic Partial Nephrectomy

Ventilation Management

• The American Thoracic Society recommends increasing FiO2 to 100% in patients with poor tidal volumes during argon-beam coagulator use 1
• The American College of Chest Physicians suggests maintaining normocapnia (PaCO2 5.0-5.5 kPa or 35-40 mmHg) in patients with poor tidal volumes during argon-beam coagulator use 2, 1
• The World Journal of Emergency Surgery recommends switching to lung-protective ventilation strategy with low tidal volume (6-8 ml/kg predicted body weight) in patients with poor tidal volumes during argon-beam coagulator use 3, 4
• The Hepatology society suggests maintaining plateau pressure <30 cmH2O in patients with poor tidal volumes during argon-beam coagulator use 6
• The World Journal of Emergency Surgery recommends considering recruitment maneuvers using the lowest effective pressure for the shortest effective time in patients with poor tidal volumes during argon-beam coagulator use 3

Assessment for Gas Embolism

• The American College of Cardiology recommends monitoring for oxygen desaturation in patients with poor tidal volumes during argon-beam coagulator use 1

If Cardiovascular Collapse Occurs

• The American Heart Association recommends beginning cardiopulmonary resuscitation per ACLS protocols in patients with cardiovascular collapse during argon-beam coagulator use 2

Pitfalls to Avoid

• The Critical Care society warns that hyperventilation can worsen hemodynamic compromise in patients with gas embolism 2, 1
• The Hepatology society suggests that excessive PEEP can further impede venous return in an already compromised patient 4