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PubMed2003

Does high-pressure carbon dioxide insufflation facilitate mucosal dissection in transanal endorectal pull-through? A rabbit model.

The aim of the present study was to investigate whether high-pressure carbon dioxide insufflation facilitates mucosal dissection in the transanal endorectal pull-through (TEPT) operation performed in Hirschsprung's disease in a rabbit model. In the study, ten New Zealand rabbits were used. In six of the rabbits, CO(2) under 50 mmHg pressure was insufflated into the submucosal area through a 25-gauge scalp needle inserted 0.3 cm over the dentate line. Two of the rabbits were taken for histopathological examination. In four rabbits, the TEPT operation was performed and in another four the operation was performed without CO(2) insufflation. Histopathological examination in the CO(2)-insufflated group of rabbits showed that at transversal incisions mucosa was seen to be separated circumferentially from submucosa by high pressure CO(2) and at longitudinal incision the separation was seen to be complete along the anal canal. It was noted that mucosal dissection was rapid, non-bloody and without induced mucosal tears or perforation; however, in the non-insufflated group the operation was time-consuming, bloody and more difficult to perform and needed meticulous care. In the present study, it was seen that submucosal high pressure CO(2) insufflation in rabbits facilitates mucosal dissection in the TEPT operation and is easy to perform, time-saving and highly economical.

Air Pressure↗

PubMed2002

Helium vs carbon dioxide gas insufflation with or without saline lavage during laparoscopy.

BACKGROUND: Helium is an inert gas that, if used for insufflation during laparoscopy, may be followed by less postoperative pain than carbon dioxide (CO2) insufflation, due to a more limited effect on intraabdominal pH and metabolism. Saline lavage has also recently been shown to reduce postoperative pain following laparoscopic surgery. To evaluate these possibilities and to better define the clinical safety of helium insufflation, we undertook a prospective randomized trial comparing CO2 and helium insufflation with or without saline lavage in patients undergoing elective laparoscopic upper abdominal surgery. METHODS: From January to November 2000, 173 patients undergoing elective laparoscopic cholecystectomy or fundoplication were randomized to undergo laparoscopy with either CO2 or helium insufflation. Within each group, patients were further randomized to undergo peritoneal lavage with 2 L of 0.9% saline at the end of the surgical procedure. This yielded the following four patient groups; CO2 (group 1, n = 47), CO2 + saline lavage (group 2, n = 43), helium (group 3, n = 43) and helium + saline lavage (group 4, n = 40). Patients were blinded to their randomization, and post-operative assessment was also performed by a blinded investigator, who applied a standardized scoring system to assess postoperative pain. RESULTS: The study groups were well matched for age, sex, weight, American Society of Anesthesiologists (ASA) status, duration of surgery, and volume of gas utilized, and 81% of patients were discharged within 48 h. There were no differences in the incidence of postoperative complications among the study groups, and postoperative pain scores were not significantly different when all four groups were compared. When helium (groups 3 and 4) was compared with CO2 (groups 1 and 2), no differences in pain score were seen. When no lavage (groups 1 and 3) was compared with lavage (groups 2 and 4), less pain was found in the group undergoing saline peritoneal lavage (mean 4-h pain score, 5.9 vs 5.2; 24-h pain score, 4.8 vs 4.1; p > 0.05). CONCLUSIONS: The use of helium insufflation for laparoscopic surgery, while not associated with any significant adverse sequelae, was not associated with less postoperative pain in this trial. The use of saline peritoneal lavage was associated with less pain in the early postoperative period.

Abdominal Pain↗

PubMed2003

The impact of carbon dioxide and helium insufflation on experimental liver metastases, macrophages, and cell adhesion molecules.

BACKGROUND: Laparoscopic insufflation, proposed to reduce hepatic perfusion, may enhance hepatic tumor spread. It is unknown whether intraabdominal pressure or the gas itself influences hepatic tumor growth. In contrast to carbon dioxide, the alternative gas helium is believed to reduce malignant cell growth. METHODS: For this study, 36 WAG/Rij rats were randomized in two experimental groups. The animals were laparoscopically insufflated with carbon dioxide ( n = 19) or helium gas ( n = 17). Liver metastases were induced by laparoscopic injection of 50,000 CC531 cells into the portal vein. Macroscopic and microscopic analyses of CC531 tumor cell growth, macrophages, and CD44v5, v6 were performed. Data were analyzed by Kruskal-Wallis, Dunn, and Holm tests. RESULTS: No significant differences in macroscopic and microscopic analyses were found between carbon dioxide and helium gas insufflations ( p > 0.05). CONCLUSIONS: Recent studies have shown that insufflation with carbon dioxide may result in increased hepatic tumor growth. The current study comparing carbon dioxide and helium insufflations could show for the first time either oncologic nor immunologic differences in relation to the liver between two different gases. In conclusion, elevated intraabdominal pressure during gas insufflation is responsible for hepatic disadvantages during pneumoperitoneum, not carbon dioxide gas itself.

Animals↗

PubMed1996

Selective lung ventilation during thoracoscopy: effects of insufflation on hemodynamics.

BACKGROUND: Positive-pressure insufflation during thoracoscopy has been advocated by some authors to facilitate exposure of the intrathoracic structures by expediting collapse of the lung. We hypothesized that insufflation during thoracoscopy may result in hemodynamic compromise despite selective lung ventilation. METHODS: After placement of invasive monitoring lines, six adult swine underwent selective lung ventilation and thoracoscopy. Baseline measurements of hemodynamic indices were taken before selective lung ventilation. The right lung then was collapsed; data were obtained at insufflation pressures up to 10 mm Hg and were compared with baseline values using Student's t test. RESULTS: Cardiac index, mean arterial pressure, and left ventricular stroke work index decreased, whereas pulmonary artery and central venous pressures increased (p < 0.05) at insufflation pressures of 5 mm Hg and greater. CONCLUSIONS: Positive-pressure insufflation during thoracoscopy resulted in significant hemodynamic compromise despite the use of selective lung ventilation. Conversion to thoracotomy may be an alternative if positive-pressure insufflation is necessary to perform the thoracoscopic procedure.

Animals↗

PubMed1994

Hemodynamic and ventilatory effects of abdominal CO2 insufflation at various pressures in the young swine.

Laparoscopic procedures requiring abdominal CO2 insufflation are applied with increasing frequency to the pediatric age group. Whereas the physiological effects accompanying insufflation have been studied in laboratory and clinical adult subjects, little is known of these effects in the juvenile subject. Young swine (weight, 10 to 12 kg, approximate age, 6 weeks) were subjected to abdominal CO2 insufflation at 10 and 15-mm Hg insufflation pressures (IP) to evaluate potential metabolic and hemodynamic effects. After intubation, minute ventilation was adjusted to obtain a baseline PCO2 between 38 and 42 mm Hg, and was kept constant during the subsequent study period. Four subjects underwent a total of eight trials, with insufflation periods of 1 hour each. Serial measurements of peak ventilatory pressure, tidal volume, end tidal CO2, arterial pH, PCO2, PO2, right atrial (RA), and inferior vena caval (IVC) pressure were obtained. Mean pH decreased from 7.45 +/- 0.03 to 7.22 +/- 0.03 at 10 mm Hg IP, and from 7.44 +/- 0.01 to 7.19 +/- 0.03 at 15 mm Hg IP. Mean PCO2 increased from 39.9 +/- 0.4 to 70.0 +/- 1.0 mm Hg at 10 mm Hg IP, and from 39.9 +/- 0.5 to 76.8 +/- 1.6 mm Hg at 15 mm Hg IP. PO2 decreased by approximately 37% at both IPs. End-tidal CO2 increased by 53% at 10 mm Hg IP, and by 68% at 15 mm Hg IP. Right atrial pressure did not increase significantly, and IVC pressure increased in proportion to the IP. Abdominal CO2 insufflation in this model produced marked acidemia, hypercapnia, decreased oxygenation, and increased exhaled CO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

PubMed1994

Effects of intraabdominal CO2 insufflation in the piglet.

Adult intraabdominal surgery performed with the minimal-access technique has created a revolution in surgery. This technique has remained largely unused for pediatric surgical procedures because of concerns regarding its safety and efficacy. Presently, intraabdominal insufflation of CO2 is the preliminary step to performing minimal access surgery. In this study, an animal model was developed to determine the effects of intraabdominal CO2 insufflation in the infant. Eight piglets (4 to 6 kg; 14 to 19 days of age) were instrumented under fentanyl anesthesia to allow measurement of arterial blood pressure (BP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), inferior vena cava pressure (IVCp), inferior vena cava flow (IVCf), mediastinal pressure (Mp), partial pressure of CO2 (PaCO2), and minute ventilation (VE) at baseline and during 1 hour of CO2 insufflation to a pressure of 15 mm Hg and again when ventilation was increased to control PaCO2 levels. Continuous recording of data allowed time-course analysis of 15-minute blocks to determine the rate of change of measured variables. A second group of 6 piglets (4 to 6 kg) underwent the same instrumentation, but their baseline values were compared with those during N2O insufflation to isolate the effects of increased intraabdominal pressure. During CO2 insufflation alone, PaCO2 increased by 31% (P < .0001). This increase occurred within the first 15 minutes of insufflation and then remained stable. The increase was likely the result of increased CO2 absorption from the peritoneal cavity because VE was unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Effect of carbon dioxide insufflation on free internal thoracic artery flows: is it a vasodilator?

BACKGROUND: This study was conceived to evaluate the effect of carbon dioxide insufflation on free internal thoracic artery flows. METHODS: We studied 56 consecutive patients who underwent coronary artery bypass grafting in which the left internal thoracic artery was anastomosed to the left anterior descending artery. The first 26 consecutive internal thoracic arteries were harvested as a pedicled graft (group 1), and the next 30 consecutive internal thoracic arteries were dissected by using the carbon dioxide insufflation technique (group 2). The internal thoracic artery harvesting was performed by 2 experienced surgeons by using the same instrumentation and technique. First, free flows of the internal thoracic arteries were registered after distal cutting of the vessel in both groups. After the first measurements, diluted papaverine was sprayed on the internal thoracic artery pedicle only in group 1, and then second measurements were registered after 15 minutes in both groups. Hemodynamic parameters were recorded with each measurement. RESULTS: The first free flow measurement was significantly higher in the carbon dioxide-insufflated internal thoracic arteries (group 2, 60 +/- 32 mL/min; group 1, 28 +/- 19 mL/min; P <.05). Although the second free flow measurement of the carbon dioxide-insufflated group was higher than in group 1, the difference was not statistically significant (68 +/- 46 mL/min vs 53 +/- 32 mL/min; P =.53). CONCLUSIONS: Carbon dioxide insufflation of the internal thoracic artery is an efficient technique to increase the flow and seems to be safe, simple, and reliable. When the internal thoracic artery is harvested in a carbon dioxide-insufflated fashion, arterial spasm and reduced early flow may be avoided, even without vasodilator agents such as papaverine.

Carbon Dioxide↗

PubMedDate not supplied

Prospective randomized trial of heated humidified versus cold dry carbon dioxide insufflation during laparoscopic gastric bypass.

BACKGROUND: The replacement of cold dry carbon dioxide with heated humidified gas for insufflation during complex laparoscopic procedures has been reported to decrease hypothermia and peritoneal cell desiccation, with a resultant decrease in postoperative pain and narcotic use and a shortened recovery, but may prevent the paralysis of the peritoneal polymorphonuclear cell cytokine cascade and add to the cost of the procedure. We report our outcomes comparing carbon dioxide insufflation with different characteristics during laparoscopic gastric bypass. METHODS: Fifty consecutive patients were randomized to undergo laparoscopic gastric bypass with either cold-dry or heated-humidified carbon dioxide insufflation. Statistical analysis of variance between groups was determined by Levine's t test with the Greenhouse-Geisser correction, at a significance level of P <.05. RESULTS: The two groups were similar for preoperative gender, age, weight, body mass index, and baseline C-reactive protein. The intraoperative room and patient core temperature, liters of insufflation used, lens cleanings, operating time, recovery room time, and narcotics used were not significantly different. The postoperative subjective analog shoulder pain score was significantly less (P = .025) for the heated-humidified group at 18 hours, but not at 6, 12, 24, or 48 hours. The abdominal pain scores and overall narcotic use, postoperative C-reactive protein, and length of stay were not significantly different between the two groups. CONCLUSION: Heated-humidified insufflation resulted in a transient reduction in subjective shoulder pain at 18 hours postoperatively, but no reduction in abdominal pain or narcotics used. We were unable to verify any clinically significant difference between the two groups comparing heated-humidified and cold-dry insufflation after laparoscopic gastric bypass.

Adult↗

PubMed1986

Carbon dioxide-insufflated colonoscopy: an ignored superior technique.

Colonoscopy and barium enema are complementary studies in the diagnosis of the cause of lower intestinal bleeding. The air usually insufflated during colonoscopy often makes it impossible to perform a good barium enema on the same day. As a possible solution to this problem, we studied the quality of barium enemas performed immediately following carbon dioxide-insufflated colonoscopy. All 15 patients who underwent unsuccessful total colonoscopies using carbon dioxide insufflation were able to have barium enemas performed the same day in contrast to only one out of 15 patients who had air-insufflated colonoscopy. In a survey of all hospitals in Illinois with 150 beds or more, we found only 15 of 146 hospitals used carbon dioxide for colonoscopy insufflation. We recommend the routine use of carbon dioxide for colonoscopic insufflation not only for greater safety and comfort for the patient, but also for the convenience and cost savings.

Adult↗

PubMed2000

Effects of CO2 insufflation and laparotomy on wound healing in mice.

BACKGROUND: The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wound healing in a murine incisional wound healing model. METHODS: Seventy-two male Swiss Albino mice were randomly allocated into three groups of control, laparotomy and CO2 insufflation. A transverse skin incision of 15 mm was made in the dorsum of each mouse, and four interrupted mattress sutures with 4.0 polypropylene thread were laid for wound closure. A median laparotomy was performed in the laparotomy group. CO2 insufflation was performed with an intra-abdominal pressure of 9 mmHg. The retained gas was evacuated from the abdominal cavity at the end of a 60-min period. Mice were killed on the 3rd, 7th and 15th postoperative days. The wound tensile strength and 5-hydroxyproline concentration in the wound tissue were measured. RESULTS: Tensile strength of the incised skin increased as the post-incision period progressed. There was no significant difference between the tensile strengths of the incised skin of control, laparotomy and CO2 insufflation groups throughout the observation period. The skin 5-hydroxyproline concentrations of all groups were not significantly different at the 3rd postoperative day. But laparotomy and CO2 insufflation groups had lower 5-hydroxyproline concentrations at the 7th and 15th postoperative days, when compared to controls (P < 0.02 for 7th and 15th days). CONCLUSION: CO2 insufflation and laparotomy reduce the 5-hydroxyproline concentration of the wound, suggesting a diminished wound healing capacity.

Animals↗

PubMed2000

Experimental study of effect of embolism of different laparoscopy insufflation gases.

BACKGROUND AND PURPOSE: Whilst carbon dioxide is the gas generally used for insufflation during laparoscopy, several studies have reported adverse effects specifically associated with its use. These effects may be attributable to chemical, metabolic, or immunologic effects specific to CO2. Because helium is chemically, physiologically, and pharmacologically inert, it has been suggested as a possible substitute insufflation gas. However, there has been concern about the potential implications of venous gas embolism during helium insufflation. The aim of this study was to examine the physiological effect of the intravenous injection of He and CO2 in an experimental model. MATERIALS AND METHODS: Eleven domestic white pigs were randomly allocated to receive multiple intravenous injections of increasing volumes of either CO2 or He gas. Cardiorespiratory function was measured, and the intravenous volumes of gas that resulted in cardiac arrest were determined. RESULT: Cardiorespiratory functional measures returned to normal quicker after CO2 than after He injection. Helium injection quickly overwhelmed the animal's ability to compensate and resulted in death at a lower volume than did CO2 injection. CONCLUSIONS: Gas embolism during He insufflation is more likely to be lethal than is CO2 embolism. This scenario is most likely following Veress needle insertion into a large vein. Therefore, if He is to be used for insufflation during clinical laparoscopy, the possibility of venous injection should be minimized by avoiding Veress needle use. Further investigation of the safety of He insufflation is warranted before a role during clinical laparoscopy can be recommended.

Animals↗

PubMed1998

The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain.

Shoulder pain (SP) is frequently mentioned in recent literature following laparoscopic operations. In the literature, many causes have been declared to explain shoulder pain after CO2 insufflation, such as direct peritoneal irritation of the CO2 gas, excessive traction of the triangular ligament, and overstretching of the diaphragmatic muscle fibers due to the high rate of insufflation. This study was planned as multicentric, and 76 patients, aged between 35 to 45, were entered into the study. They were all selected by a randomized sampling method, with equal numbers of men and women, to achieve true evaluation. The low flow-rate (LFR) group was insufflated with 2.5 L/min and the high flow-rate (HFR) group with 7.5 L/min. All cases were evaluated by subjective pain classification on postoperative day 3. According to the subjective pain scale method, shoulder pain average was 23.9+/-3.1 in the LFR group and 55.4+/-6.5 in the HFR group. The difference between these groups was significant (p > 0.01). There is no significant difference for the operation time (LFR%: 64+/-15 minutes, HFR: 61+/-20 minutes, p > 0.05). Our results suggest that there is a significant statistical relation between the postoperative shoulder pain levels and increased insufflation rates. For this reason, low insufflation rate significantly reduces the shoulder pain but does not increase the operation time. Therefore, a low insufflation rate should be applied in all cases for patients' comfort and safety.

Adult↗

PubMed1994

Carbon dioxide absorption is not linearly related to intraperitoneal carbon dioxide insufflation pressure in pigs.

BACKGROUND: Carbon dioxide absorption into the blood during laparoscopic surgery using intraperitoneal carbon dioxide insufflation may lead to respiratory acidosis, increased ventilation requirements, and possible serious cardiovascular compromise. The relationship between increased carbon dioxide excretion (VCO2) and intraperitoneal carbon dioxide insufflation pressure has not been well defined. METHODS: In 12 anesthesized pigs instrumented for laparoscopic surgery, intraperitoneal carbon dioxide (n = 6) or helium (n = 6) insufflation pressure was increased in steps, and VCO2 (metabolic cart), dead space, and hemodynamics were measured during constant minute ventilation. RESULTS: VCO2 increases rapidly as intraperitoneal insufflation pressure increases from 0 to 10 mmHg; but from 10 to 25 mmHg, VCO2 does not increase much further. PaCO2 increases continuously as intraperitoneal insufflation pressure increases from 0 to 25 mmHg. Hemodynamic parameters remained stable. CONCLUSIONS: By considering Fick's law of diffusion, the initial increase in VCO2 is likely accounted for by increasing peritoneal surface area exposed during insufflation. The continued increase in PaCO2 without a corresponding increase in VCO2 is accounted for by increasing respiratory dead space.

Absorption↗

PubMed1996

Chest vibration redistributes intra-airway CO2 during tracheal insufflation in ventilatory failure.

OBJECTIVE: To determine if high-frequency external chest wall vibration added to low flow intratracheal fresh gas insufflation alters the intra-airway CO2 distribution and the resistance to CO2 transport from the lungs. DESIGN: Prospective study. SETTING: Experimental laboratory. SUBJECTS: Six adult anesthesized and paralyzed mongrel dogs (mean weight 24.3+/- 4.4 kg). INTERVENTIONS: Dogs were ventilated by three methods: a) intermittent positive pressure ventilation; b) intermittent positive pressure ventilation with tracheal insufflation of fresh gas (FIO2 of 0.4) flowing at 0.15 L/kg/min through a catheter positioned at the carina; and c) intermittent positive pressure ventilation with tracheal insufflation and with external high-frequency chest wall vibration of the dependent hemithorax. MEASUREMENTS AND MAIN RESULTS: We measured arterial blood gas values as an index of global gas exchange, and intrapulmonary airway CO2 concentrations as an index of local gas exchange. Intra-airway CO2 concentrations along the axis of the airways were measured via a sampling catheter. Airway axial concentration profiles were constructed and resistances to gas transport were calculated from the measured data. Vibration increased intraluminal CO2 concentrations from 1.1% to 2.5% mouthward of the insufflation catheter tip. Peak resistance to CO2 transport decreased by 65% during vibration relative to the insufflation-only value. Vibration displaced peak transport resistance from second- to fourth-generation airways. CONCLUSIONS: Global gas exchange improves during ventilation by chest wall vibration with low flow insufflation. Local gas exchange in the central airways is also improved due to increased intraluminal mixing and CO2 elimination. This ventilation technique may confer therapeutic advantages over conventional mechanical ventilation in the treatment of ventilatory failure.

Airway Resistance↗

PubMed2001

Effects of abdominal Co2 insufflation on renal and hepatic blood flows during acute hemorrhage in anesthetized pigs.

OBJECTIVE: To evaluate the consequences of laparoscopy during hemorrhage, we studied the respiratory, renal, and hepatic blood flow changes induced by abdominal Co2 insufflation during severe hemorrhage in anesthetized pigs. DESIGN: Prospective animal study. SETTING: University research laboratory. SUBJECTS: Anesthetized and ventilated pigs (n = 18). INTERVENTIONS: The right carotid artery was cannulated to measure mean arterial pressure. A pulmonary artery catheter was inserted to measure mean pulmonary arterial pressure and cardiac output. After a midline abdominal incision, three flow probes were positioned around the portal vein, the hepatic artery, and the renal artery to measure portal vein blood flow, hepatic artery blood flow, and renal blood flow. To induce hemorrhage, blood was withdrawn until mean arterial pressure reached 50 mm Hg. Laparoscopy was mimicked by insufflating Co2 until intra-abdominal pressure reached approximately 15 mm Hg. Measurements were collected during hemorrhage, Co2 abdominal insufflation, and the combination of both interventions. MEASUREMENTS AND MAIN RESULTS: Severe pulmonary hypertension and hypercapnic acidosis occurred during abdominal Co2 insufflation. However, the abdominal Co2 insufflation did not aggravate the cardiac output and total hepatic blood flow changes induced by acute hemorrhage, whereas the combination of hemorrhage and abdominal Co2 insufflation markedly altered renal blood flow. CONCLUSIONS: These results suggest that renal function must be monitored carefully when performing laparoscopy in trauma patients. In contrast, hepatic perfusion seems well preserved.

Analysis of Variance↗

PubMed2003

Abdominal insufflation for prevention of exsanguination.

BACKGROUND: Currently, traumatic intra-abdominal hemorrhage continues unchecked during transport and triage, and a simple technique of prehospital hemostasis might improve outcomes. The hemostatic effect of abdominal hypertension has not been studied. PURPOSE: To examine the effect of iatrogenic abdominal insufflation on blood loss and hemodynamic performance after major abdominal vascular injury. METHODS: Following laparotomy, a 2.7 mm hole was created in the inferior vena cava of 10 anticoagulated pigs and controlled with a partially occlusive, laparoscopic vascular clamp. After abdominal closure the clamp was released and the pig was randomized to either control (n = 5) or immediate abdominal CO2 insufflation at 20 cm H2O pressure (n = 5). Lactated Ringer's solution was used as needed to maintain a mean arterial pressure of 60 mm Hg. After 15 minutes of hemorrhage and hemodynamic monitoring, the animals were killed and blood loss measured. Mean blood loss was compared between groups using the Student test, as were final values for physiologic variables. Temporal changes in physiologic parameters were compared using analysis of variance. RESULTS: Mean blood loss was reduced by 61% in insufflated pigs versus controls (695 +/- 244 versus 1764 +/- 328 cc, p < 0.001). Compared with controls, insufflated pigs had significantly higher mean arterial pressure (64 versus 25 mm Hg, p < 0.001), end-tidal CO2 (40.8 versus 17.8 mm Hg, p < 0.001), and pulmonary capillary wedge pressure (10.2 versus 5.8 mm Hg, p = 0.026) immediately before the pigs were killed. CONCLUSION: Iatrogenic abdominal insufflation significantly decreased blood loss and improved hemodynamics in a porcine model of traumatic venous hemorrhage. Iatrogenic abdominal insufflation may be useful in the prehospital management of abdominal injury.

Animals↗

PubMed1998

Cardiopulmonary changes associated with abdominal insufflation of carbon dioxide in mechanically ventilated, dorsally recumbent, halothane anaesthetised horses.

The use of laparoscopy for the diagnosis or therapeutic management of abdominal disease in the horse has distinct advantages when it allows the horse to remain standing. However, distending the abdomen by insufflation of a biologically active gas in an anaesthetised horse may add to the physiological challenge of general anaesthesia and recumbency. The cardiopulmonary responses to abdominal insufflation with carbon dioxide (CO2) to 15 mmHg pressure were evaluated in 6 horses in dorsal recumbency anaesthetised with halothane in oxygen and subjected to laparoscopic colopexy. Vaporiser settings targeted a fractional expired halothane of 1.5 MAC and a clinically acceptable depth of anaesthesia. Pressure and rate controlled positive pressure ventilation was adjusted to an ETCO2 of 35 mmHg before abdominal insufflation and was not changed thereafter. Cardiopulmonary data were collected before, at 30 and 60 min during and 30 min after CO2 insufflation. ANOVA for repeated measures followed by Tukey's protected t test were used to determine differences. Partial pressure of oxygen and pH of arterial blood, tidal volume and systemic vascular resistance decreased during abdominal insufflation and laparoscopic surgery whereas mean arterial blood pressure, right atrial pressure, cardiac index, stroke index, partial pressure of CO2 in arterial blood and end tidal respiratory gases, and calculated physiological shunt increased significantly. Only systemic vascular resistance returned to the pre-insufflation level after desufflation. The hypercapnia, acidosis and apparent increase in cardiac work that accompany CO2 pneumoperitoneum for laparoscopic surgery could place the anaesthetised horse at additional risk of perioperative complications.

Abdomen↗

PubMed2002

NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy.

BACKGROUND: To eliminate the risk of combustion during electrosurgical procedures and to reduce patient discomfort, carbon dioxide (CO2) insufflation has been recommended during colonoscopy. However, air insufflation is still the standard method, perhaps due to the lack of suitable equipment and shortage of randomised studies. AIMS: This randomised controlled trial was conducted to assess patient tolerance and safety when using CO2 insufflation during colonoscopy. PATIENTS: Over an eight month period a successive series of patients referred for a baseline colonoscopy due to findings in a flexible sigmoidoscopy screening trial were randomly assigned to the use of either air or CO2 insufflation during colonoscopy. METHODS: End tidal CO2 (ETCO2), a non-invasive parameter of arterial pCO2, was registered before and repeatedly during and after the examination. The patient's experience of pain during and after the examination was registered using a visual analogue scale (VAS). Sedation was not used routinely. RESULTS: CO2 insufflation was used in 121 patients (51%) and air in 119 patients (49%). The groups were similar in age, sex, and caecal intubation rate. No rise in ETCO2 was registered. There were statistically significant differences in VAS scores between the groups with less pain reported when using CO2. CONCLUSIONS: This randomised study of unsedated patients shows that CO2 insufflation is safe during colonoscopy with no rise in ETCO2 level. CO2 was found to be superior to air in terms of pain experienced after the examination.

Air↗