The effect of carbon dioxide insufflation on cognitive function during cardiac surgery.

The use of carbon dioxide (CO(2)) insufflation into the pericardial well has become widespread, and in some units routine. The rationale behind this practice is the fact that CO(2) is more soluble than air leading to fewer gaseous microemboli entering the bloodstream and being transferred to the brain or heart. However, the evidence that this reduces postoperative neurocognitive decline is scant. Although CO(2) insufflation is generally a safe procedure there are case reports of significant complications. The aim of this systematic review is to analyze the current evidence for this practice.