Hazards with electrocautery-induced decomposition of fatty acids - in view of lipid embolization

Objectives. Electrocautery is an appreciated surgical tool, which however, generates immense heat and fat-tissue melting. In cardiac surgery, liquefied fat collects on the surface of blood in the pericardial cavity and becomes aspirated by the heart-lung machine for aortic recycling. Deposits seen in the brain microcirculation after surgery are caused by lipid embolism. This study investigates lipid chemistry, whether heat from electrocautery generates fatty-acid fragmentation and decomposition. Design. Pericardial fat tissue was sampled from cardiac-surgery patients and from piglets. The human tissue was exposed to electrocautery, or to fixed temperatures in an in vitro model. Fatty-acid decomposition was explored by solid-phase microextraction gas chromatography and the distribution of fatty acids was measured. Results. Fatty-acid decomposition demonstrated a temperature-effect relationship (p=0.007). At 350 degrees C the proportion of polyunsaturated fatty acids became heavily reduced or were abolished (p=0.016). Electrocautery resulted in similar changes. Conclusions. Electrocautery induces a profound fatty-acid fragmentation to form short-chained compounds. The chemical and toxic nature of these compounds remains to be determined, including their clinical implications at blood recycling in cardiac surgery.