Model Predictions of Gas Embolism Growth and Reabsorption during Xenon Anesthesia

Abstract

Background It is not readily obvious whether an intravascular bubble will grow or shrink in a particular tissue bed. This depends on the constituent gases initially present in the bubble, the surrounding tissue, and the delivered gas admixture. The authors used a computational model based on the physics of gas exchange to predict cerebrovascular embolism behavior during xenon anesthesia. Methods The authors estimated values of gas transport parameters missing from the literature. The computational model was used with those parameters to predict bubble size over time for a range of temperatures (18 degrees -39 degrees C) used during extracorporeal circulation. Results Bubble size over time is highly nonlinearly dependent on multiple factors, including diffusivity, solubility, gas partial pressures, magnitude of concentration gradients, vessel diameter, and temperature. Xenon- and oxygen-containing bubbles continue to grow during xenon delivery. Bubble volume doubles from 50 to 100 nl in approximately 3-68 min, depending on initial gas composition and bubble shape. Bubble growth and reabsorption are relatively insensitive to temperature in the physiologic and surgical range. Conclusions Xenon anesthesia results in gas exchange conditions that favor bubble growth, which may worsen neurologic injury from gas embolism. The concentration gradients can be manipulated by discontinuation of xenon delivery to promote reabsorption of xenon-containing bubbles. Estimated growth and reabsorption rates at normothermia can be applied to temperature extremes of cardiopulmonary bypass.