Asian Cardiovasc Thorac Ann 2001;9:248-249
© 2001 Asia Publishing EXchange Pte Ltd
Even a Root Canal Has Its Advantages: Dental Syringe as a Mist Blower
Harinder Singh Bedi, MCh,
Maninder Singh Kalkat, MCh
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Tagore Heart Care & Research Centre Jalandhar, Punjab, India
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For reprint information contact: Harinder Singh Bedi, MCh Tel: 91 172 39 6235 Fax: 91 172 39 6221 email: bedi{at}fortis.co.in Department of Cardiovascular Surgery, Fortis Heart Institute, Sector 62, Phase VIII, Mohali, Punjab 160055, India.
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Abstract
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In coronary artery surgery, especially during off-pump procedures and when continuous retrograde warm blood cardioplegia is used, a gentle but effective system is required to improve visualization without desiccating tissues. A simple, efficient, reusable, and very cost-effective device is described.
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INTODUCTION
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In coronary artery surgery, especially during off-pump procedures and when continuous retrograde warm blood cardioplegia is used, coronary blood flow (native or retrograde) hinders a clear view of the arteriotomy. Taking the idea from a dentist's syringe, we devised a system to deliver an alterable mixture of saline and oxygen to produce a column of mist that gently pushes blood away from the anastomosis site, without desiccating delicate tissues.
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TECHNIQUE
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The dental 3-way syringe (J Morita Corporation, Tokyo, Japan) is made of stainless steel. It has a 12-cm handle with a double-lumen system. The handle connects to a screw-on nozzle of 8 cm in length (Figure 1
). The device can be easily operated in a standard operating room setting. Medical-grade oxygen from the central supply is connected by tubing after passing through a 0.2-µm antibacterial inlet filter and started at a rate of 2 to 5 L•min–1. Saline from a pressurized bottle is connected by means of another tube. The saline and oxygen mix in the nozzle to produce a fine mist. There are two knobs on the handle by which an assistant can initiate and control the delivery of oxygen and saline. The tip of the nozzle is held at a distance of 5 to 10 cm away from the arteriotomy site (Figure 2). The blower distends the arteriotomy for suture placement, avoiding the need to touch the vessel wall with forceps. The mist prevents drying of the conduit, the arteriotomy, and surrounding tissue. Precise control of both oxygen and saline flow prevents too forceful a jet from being produced, which could damage intima or produce a dissection. Carbon dioxide may be used instead of oxygen to reduce the danger of gas embolism.
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Figure 1. The dental syringe used as a mist blower. A = nozzle that screws onto the handle, B = handle with two lumens (small black arrows), C = obverse of handle showing the two knobs (small white arrows) for independent control of oxygen and saline flow.
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Figure 2. Intraoperative photograph showing the setup and the fine mist produced (black arrow). N = nozzle, K = knobs on the handle, T = tubing for oxygen and saline.
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DISCUSSION
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Good visualization is the most important prerequisite for accurate anastomosis which in turn is the most important factor in graft patency. In off-pump coronary surgery, some blood invariably comes into the field, in spite of techniques to occlude the coronary artery (snares or clamps). Intravascular shunts and blockers have the inherent problems of inadequate fit with leakage, difficulty of insertion, and the risks of endothelial damage, dissection, dislodgment of atheroma, air and particulate embolism, and hindrance of suturing.1 A mist blower provides a gentle means of visualization, which does not damage the endothelium.2
We have used this device in 225 off-pump procedures and 450 conventional coronary artery bypass operations with continuous retrograde warm blood cardioplegia. A clear view of the arteriotomy was always possible, in spite of significant coronary flow. The main technical advantage of this system over other commercially available devices is the fact that there is adjustable control of the composition of the mist, as separate controls for oxygen and saline are available. We advocate the use of this device as an effective, safe, easily available, reusable, and very cost-effective system for proper visualization in coronary artery bypass grafting surgery.
Presented at the 10th World Congress of The International Society of Cardio-Thoracic Surgeons, Vancouver, Canada, August 13–16, 2000, and at the 8th Annual Meeting of The Asian Society for Cardiovascular Surgery, Fukuoka, Japan, September 6–8, 2000.
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Acknowledgments
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We gratefully acknowledge the input of Dr. Sunil Malhan, Consultant Dental Surgeon, Jalandhar, India.
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REFERENCES
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Chavanon O, Perrault LP, Menasché P, Carrier M, Vanhoutte PM. Endothelial effects of hemostatic devices for continuous cardioplegia or minimally invasive operations. Ann Thorac Surg 1999;68:1118–20.[Free Full Text]
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Hoerstrup SP, Lachat ML, Zund G, Vogt PR, Turina MI. Improved visualization in minimally invasive coronary bypass grafting. Ann Thorac Surg 1998;66:963–4.[Abstract/Free Full Text]
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