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PubMed1997

Tracheal gas insufflation reduces requirements for mechanical ventilation in a rabbit model of respiratory distress syndrome.

Tracheal gas insufflation is known to lower PaCO2 in larger animal models of respiratory distress syndrome, but its ability to reduce the ventilator pressures and tidal volume needed to achieve an acceptable PaCO2 has not been examined in small animals using modes of ventilation employed in neonatal intensive care. In this study, the effect of insufflating humidified gas into the lower trachea was examined in a saline lung lavage model of respiratory distress syndrome in rabbits, while the peak airway pressure during conventional pressure-limited ventilation was adjusted to keep the PaCO2 approximately constant. Tracheal gas insufflation significantly reduced the peak airway pressure required and reduced the delivered tidal volume but did not affect the AaDO2. The effects were more marked at a ventilator rate of 30 breaths per minute than at 60 bpm and more during continuous insufflation than when gas was insufflated only during expiration. These results suggest that tracheal gas insufflation may reduce the risk of ventilation-induced lung disease in the newborn.

Animals↗

PubMed2002

The cardiopulmonary effects of single-lung ventilation and carbon dioxide insufflation during thoracoscopic internal mammary artery harvesting.

BACKGROUND: Thoracoscopic internal mammary artery harvesting has become an integral part of minimally invasive coronary artery bypass operations. The technique involves the use of single-lung ventilation and carbon dioxide insufflation to maximize exposure and facilitate rapid dissection. The hemodynamic and pulmonary effects of this technique have not been extensively studied. METHODS: Seventy-five consecutive patients undergoing a minimally invasive coronary artery bypass operation were prospectively studied intra-operatively. Sixty-six left and nine right thoracoscopic IMA harvests were performed in patients with ejection fractions ranging from 12 to 70%. Carbon dioxide insufflation was utilized in the range of 8 to 12mm Hg and the effects on cardiovascular and pulmonary performance were recorded to disk every sixty seconds. RESULTS: Carbon dioxide insufflation in combination with single-lung ventilation increases central venous pressure and pulmonary artery pressure. At higher levels of insufflation pressure, negative effects are seen on systemic blood pressure, cardiac output and left ventricular stroke work. These effects can be aggravated by hypovolemia and a poor preoperative left ventricular ejection fraction. CONCLUSIONS: Single-lung ventilation and carbon dioxide insufflation greatly enhances the technical ease of thoracoscopic internal mammary artery harvest. While safe in the majority of patients, CO2 insufflation should be used cautiously in hypovolemic patients and patients with poor left ventricular function.

Adult↗

PubMed1986

Comparative trial of tubal insufflation, hysterosalpingography, and laparoscopy with dye hydrotubation for assessment of tubal patency. World Health Organization.

A World Health Organization-sponsored multicentered trial comparing the efficacy of gaseous tubal insufflation with hysterosalpingography (HSG) and/or laparoscopy plus dye hydrotubation in the assessment of tubal patency was undertaken. Three hundred ninety-three women in eight centers were involved (365 insufflations, 289 HSG, 189 laparoscopy). Patency was proven positive in 56% of insufflation, 45% of salpingography, and 52% of laparoscopy cases. Laparoscopy showed some women to have fibroids and a number of others to have ovarian abnormalities, endometriosis, pelvic adhesions, and/or congenital uterine malformation. Comparison of insufflation and HSG showed a false-positive rate of 42% and false-negative rate 24% in 363 cases. The false-positive rate of insufflation versus laparoscopy was 35% and the false-negative rate 38% of 180 cases. Only 55% of 125 women undergoing both HSG and laparoscopy had similar findings. The results suggest that gaseous tubal insufflation should not be employed as a method of investigating tubal patency. Diagnostic reliability of HSG is poor, but it is useful as a primary screening procedure, particularly when complimented with laparoscopy plus dye hydrotubation, which is the optimum method not only for assessing tubal patency but for discovering other hitherto unsuspected disease.

Clinical Trials as Topic↗

PubMed1994

[Changes of arterial CO2 (PaCO2) and urine output by carbon dioxide insufflation of the peritoneal cavity during laparoscopic cholecystectomy].

We studied on the effects of carbon dioxide insufflation during laparoscopic cholecystectomy on the arterial blood gas analysis and urine output. Intra-abdominal pressure was increased up to either 10cmH2O or 15cmH2O, and we compared the PaCO2 values before and during insufflation. Both increase of PaCO2 and decrease in pH were larger in intra-abdominal pressure of 15cmH2O than 10cmH2O. In the intra-abdominal pressure 15cmH2O group, the increase of PaCO2 by CO2 peritoneal insufflation was significantly larger in operative time of more than 60 minutes group than in less than 60 minutes group, but no significant changes were observed in 10cmH2O group. In the group of obesity index of more than 120, elevation levels of PaCO2 by CO2 insufflation were significant, but in the group of less than 120 no significant elevation were observed. The tendency that the urine output during operation was decreased as increase of intra-abdominal pressure or operative time, but the obesity had no definite effects on urine output. Insufflation of the abdomen with CO2 caused large changes in PaCO2 or pH in the patients with a previous history of major cardiopulmonary disorder. It was shown that the low insufflation pressure and short operative time is good for the maintenance of normal physiological state.

Adult↗

PubMed1993

Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy.

Intraoperative venous stasis may increase the risk for perioperative deep vein thrombosis and pulmonary embolism. To determine if abdominal insufflation during laparoscopic cholecystectomy causes venous stasis, eight patients undergoing this procedure had their left common femoral veins examined by a duplex scanner before and after abdominal insufflation; the veins then were examined again before and after deflation. The right femoral veins were catheterized to measure femoral venous pressures. Abdominal insufflation to 14 millimeters of mercury pressure increased femoral venous pressures (10.2 +/- 4.1 millimeters of mercury to 18.2 +/- 5.1 millimeters of mercury; p < 0.001) and slowed peak blood velocities (24.9 +/- 8.5 centimeters per second to 18.5 +/- 4.5 centimeters per second; p < 0.05) without changing the cross-sectional areas (1.1 +/- 0.4 centimeter squared to 1.2 +/- 1.5 centimeter squared; p = NS) of the common femoral veins. Insufflation also reduced or eliminated pulsatility in the common femoral veins in 75 percent of the patients, indicating that insufflation was causing partial proximal venous obstruction. After 80 +/- 21 minutes of surgery, these changes remained significant. Deflation of the abdomen restored normal venous pulsatility in all patients, reduced femoral venous pressures (18.5 +/- 5.2 millimeters of mercury to 12.2 +/- 9.8 millimeters of mercury; p < 0.001), increased the peak blood velocities (14.2 +/- 6.8 centimeters per second to 28.1 +/- 16 centimeters per second; p < 0.05) and decreased the cross-sectional areas (1.4 +/- 0.6 centimeters squared to 0.9 +/- 0.4 centimeters squared; p < 0.05) of the common femoral veins, indicating venous decompression had occurred. The results suggest abdominal insufflation causes venous stasis during laparoscopic cholecystectomies. Measures shown to reduce intraoperative venous stasis, such as pneumatic compressive stockings, may benefit patients undergoing these procedures.

Adult↗

PubMed1996

[Comparative study on assessment of tubal patency among tubal insufflation, hydrotubation, hysterosalpingography and chromotubation under laparoscopy].

OBJECTIVES: To compare the diagnostic value of tubal insufflation, hydrotubation, hysterosalpingography (HSG) and chromotubation under laparoscopy for tubal patency assessment. METHODS: Among 258 women who underwent chromofubation during laparoscopy procedures for infertility assessment in our hospital, tubal insufflation were performed in 42 cases, hydrotubation in 70, HSG in 63, both insufflation and hydrotubation in 20, insufflation and HSG in 11, and hydrotubation and HSG in 22. The accuracy of each method was compared with that of chromotubation under laparoscopy. RESULTS: The accuracy rates of hydrotubation (87.1%) and HSG (73.0%) were significantly higher than that of insufflation (50.0%) (P < 0.01, P < 0.05 respectively). Similar results were shown when 2 different procedures in the same patient were compared with laparoscopy. CONCLUSIONS: Tubal insufflation has no longer its place in tubal patency assessment due to its grossly inaccuracy; Both hydrotubation and HSG can be used as screening methods. Laparoscopy is the most accurate procedure in assessing tubal patency, as well as in searching pelvic abnormalities.

Adult↗

PubMed2001

A randomized controlled trial to determine the effect of humidified carbon dioxide (CO2) insufflation on postoperative pain following thoracoscopic procedures.

BACKGROUND: It has previously been shown that the insufflation of humidified gas during laparoscopy results in less postoperative pain than is observed following the use of dry gas. Experimental evidence also suggests that dry gas insufflation during thoracoscopy results in greater structural injury to the pleura than occurs with the use of humidified gas. The present study was designed to determine the effect of humidified gas insufflation on postoperative pain following thoracoscopic procedures. METHODS: Forty consecutive patients were prospectively randomized. Twenty patients were insufflated with humidified carbon dioxide (CO(2)), and 20 control patients received standard dry CO(2). RESULTS: The patients' analogue pain score was significantly lower following humidified gas insufflation compared to dry gas insufflation when assessed at 6 h postoperatively, as well as on the 1st, 2nd, 3rd, and 14th postoperative days. The postoperative morphine consumption was lower in the humidified group than it was in the control group. The incidence of respiratory complications was identical for both groups. CONCLUSION: The use of humidified gas appears to reduce postoperative pain but not the rate of respiratory complications.

Anesthesia, Inhalation↗

PubMed1999

Videoscopic surgery under local and regional anesthesia with helium abdominal insufflation.

BACKGROUND: High-risk patients may not be good candidates for laparoscopic surgery due to the metabolic consequences of transperitoneal absorption of insufflated CO(2) gas and the necessity of general anesthesia because CO(2) insufflation produces pain. Helium gas is metabolically inert and does not produce pain. Thus it permits an alternative approach to performing laparoscopic surgery in high-risk patients. METHODS: Laparoscopic cholecystectomy, appendectomy, hernia repair, and peritoneal dialysis catheter procedures were performed under local or regional anesthesia in high-risk patients utilizing helium gas as the insufflation agent. RESULTS: Twenty-one patients underwent laparoscopic procedures under local or regional anesthesia. None of the procedures initiated under local-regional anesthesia required abandonment of the laparoscopic approach or conversion to general anesthesia. There were no operative or perioperative mortalities. Two incidences of pneumothorax occurred with extraperitoneal hernia repair; one required a tube thoracostomy. CONCLUSIONS: Helium gas should be considered the agent of choice for intraperitoneal insufflation in high-risk patients not only because helium avoids the metabolic consequences of CO(2) insufflation but also because it permits selected procedures to be performed under local-regional anesthesia. Helium may be contraindicated for laparoscopic procedures involving extraperitoneal insufflation due to the increased risk for pneumothoraces.

Adult↗

PubMed1994

Hemodynamic effects of carbon dioxide insufflation during thoracoscopy.

As more complex thoracoscopic procedures are performed, adequate exposure becomes increasingly more important. The insufflation of CO2 has been demonstrated to aid in the compression of lung parenchyma and the effacement of subpleural lesions, and to act as a retractor when combined with changes in patient position. However, a recent study demonstrated that CO2 insufflation during thoracoscopy in the pig had adverse hemodynamic consequences. We prospectively studied 32 patients undergoing thoracoscopy to evaluate the effects of CO2 insufflation in the clinical setting. The end-tidal CO2 pressure, arterial oxygen saturation, mean arterial pressure, heart rate, and central venous pressure were monitored. Measurements were determined at baseline, at the initiation of one-lung ventilation, and at intrapleural pressures of 2 to 14 mm Hg. We found that the insufflation of CO2 of 2 to 14 mm Hg had no significant effect on the end-tidal CO2 pressure, arterial oxygen saturation, heart rate, or mean arterial pressure, but the central venous pressure did rise from 7.00 +/- 1.5 mm Hg to 17.30 +/- 2.53 mm Hg (p < 0.05). We conclude from this that the insufflation of CO2 during thoracoscopy does not have adverse hemodynamic effects in the clinical setting. Therefore, we propose that low-pressure (< 10 mm Hg) insufflation is a safe adjunct to the conduct of routine thoracoscopic surgical procedures.

Adult↗

PubMed1996

Talc pleurodesis: talc slurry versus thoracoscopic talc insufflation in a porcine model.

BACKGROUND: Pleurodesis using both talc slurry and thoracoscopic talc insufflation has been shown to be clinically effective. This study compares these two modalities of pleural talc instillation in an animal model. METHODS: Eleven immature pigs underwent general endotracheal anesthesia. On one side, a slurry of 5 g sterile United States Pharmacopeia talc in 50 mL of saline solution was instilled through a thoracostomy tube. On the other side, the lung was deflated and 5 g of dry talc was insufflated under thoracoscopic visualization. The animals were sacrificed 30 days later, and the quality of pleural adhesions was graded from 0 to 2 (0 = absent; 1 = light; 2 = dense) in each of six regions of each hemithorax. The distribution of adhesions on each side was graded from 0 to 6, according to the number of areas that contained adhesions. RESULTS: One animal died of anesthetic complications. Among the survivors, adhesions produced by both methods were dense and diffuse in 8 of 10 animals, and light and diffuse in 1 animal. One animal had light or absent adhesions on the talc slurry side, and dense and diffuse adhesions on the thoracoscopic talc insufflation side. There was no difference between the techniques for density of adhesion scores (talc slurry, 9.9 +/- 2.2; thoracoscopic talc insufflation, 10.0 +/- 2.5) or distribution of adhesion scores (talc slurry, 5.5 +/- 1.0; thoracoscopic talc insufflation, 5.8 +/- 0.4) (p > 0.1). CONCLUSIONS: Effective pleurodesis in a porcine model can be obtained with either talc slurry or thoracoscopic talc insufflation.

Animals↗

PubMedDate not supplied

Intraoral air pressure of alaryngeal speakers during a no-air insufflation maneuver.

Intraoral air pressure was recorded during the production of the consonant cognate pairs /p/-/b, /t/-/d, and /s/-/z/ by eight esophageal speakers. These consonants were combined with the vowel /a/ to form CV, VCV, and VC syllables and produced under two experimental conditions: after the insufflation of air and without air insufflation. The purpose was to determine if the voiced-voiceless pressure difference associated with the production of cognate pairs would occur in the absence of an insufflated air flow source. The results revealed that peak intraoral air pressure magnitudes were significantly greater following the insufflation of air than without it. Moreover, the voiceless consonants were generally produced with greater peak air pressures than the voiced consonants under both experimental conditions, although not all contrasts were significantly different. Finally, peak air pressure magnitudes were significantly more variable in the air insufflation condition. The finding that the esophageal speakers exhibited a pressure difference relative to voicing in the absence of an insufflated air flow source provides support to the concept that intraoral air pressure may be an important variable in regulating and controlling consonant production.

Aged↗

PubMed1996

Effect of subcutaneous carbon dioxide insufflation on arterial pCO2.

PURPOSE: Subcutaneous emphysema following laparoscopy could result in postoperative respiratory acidosis from prolonged CO2 absorption. We studied the magnitude and duration of alterations in PaCO2 coincident with direct CO2 insufflation into the subcutaneous fat of the anterior abdominal wall of 5 anesthetized juvenile pigs. METHODS: First, each pig was insufflated with 6 L of CO2 to produce moderate emphysema over the trunk. Following return to baseline PaCO2, each pig was re-insufflated with 12 L of CO2 to produce severe emphysema over lower limbs, neck, head, and trunk. Measurements of arterial blood gases were performed every 5 or 10 min. Minute ventilation was held constant to represent the worst case scenario. RESULTS: From baseline PaCO2 of 41.8 +/- 2.3 mm Hg, PaCO2 peaked at 68.3 +/- 8.6 (P < 0.02) and 92.9 +/- 10.7 (P < 0.01) mm Hg for the 6- and 12-L volumes, respectively, 20 to 25 minutes following insufflation. From baseline arterial pH of 7.40 +/- 0.02, respective nadirs of pH were 7.21 +/- 0.06 (P < 0.02) and 7.08 +/- 0.05 (P < 0.01). PaCO2 and arterial pH took approximately 100 minutes to return to baseline after insufflation with both 6 and 12 L volumes. CONCLUSIONS: When minute ventilation is fixed, subcutaneous CO2 insufflation causes increased PaCO2 and decreased pH that may persist for a prolonged period of time. Therefore, patients with subcutaneous emphysema after laparoscopy should be observed in postanesthetic recovery until PaCO2 and pH approach baseline.

Abdominal Muscles↗

PubMed2001

Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: a randomized clinical study.

BACKGROUND: Previous studies using animal models have demonstrated that carbon dioxide (CO2) pneumoperitoneum during laparoscopy is associated with adverse physiological, metabolic, immunological and oncological effects, and many of these problems can be avoided by the use of helium insufflation. The present study was performed in patients to compare the effect of helium and CO2 insufflation on intraperitoneal markers of immunological and metabolic function. METHODS: Eighteen patients undergoing elective upper gastrointestinal laparoscopic surgery were randomized to have insufflation achieved by using either helium (n = 8) or CO2 (n = 10) gas. Intraperitoneal pH was monitored continuously during surgery, and peritoneal macrophage function was determined by harvesting peritoneal macrophages at 5 min and 30 min after commencing laparoscopy, and then assessing their ability to produce tumour necrosis factor-alpha (TNF-alpha), and their phagocytic function. RESULTS: Carbon dioxide laparoscopy was associated with a lower intraperitoneal pH at the commencement of laparoscopy, although this difference disappeared as surgery progressed. The production of TNF-alpha was better preserved by CO2 laparoscopy, but the insufflation gas used did not affect macrophage phagocytosis. Patients undergoing helium laparoscopy required less postoperative analgesia. CONCLUSION: The choice of insufflation gas can affect intraperitoneal macrophage function in the clinical setting, and possibly acid-base balance. The present study suggested no immunological advantages for the clinical use of helium as an insufflation gas. The outcomes of the present study, however, are different to those obtained from previous laboratory studies and further research is needed to confirm this outcome.

Carbon Dioxide↗

PubMed1990

Tracheal insufflation of tumor necrosis factor protects rats against oxygen toxicity.

Tracheal insufflation of tumor necrosis factor (TNF; 5 micrograms or 1.2 x 10(5) U) markedly enhanced the survival of adult rats exposed to 100% O2: 12 of 17 rats (71%) survived for greater than 11 days, whereas 30 of 30 control (Hanks' balanced salt solution) insufflated rats (100%) died within 3 days of O2 exposure. Insufflation of gamma-interferon (5 micrograms) or intraperitoneal injection of up to 40 micrograms TNF did not afford any protection. At 55 h after O2 exposure, TNF-insufflated rats showed less pulmonary edema, as determined by the extravascular lung water content-to-bloodless lung dry weigh ratio and less alveolar capillary leak as determined by the protein content in the bronchoalveolar lavage fluid, than control insufflated rats similarly exposed. This protection against O2 toxicity by TNF insufflation was associated with increased lung superoxide dismutase, catalase, and glutathione peroxidase activities. The enhancement of lung antioxidant enzyme activities was noted at 55 h of O2 exposure, when control animals began to die of O2 toxicity. This temporal relationship suggests that TNF-induced increase in antioxidant enzyme activities contributes, at least in part, to the observed protection.

Animals↗

PubMed1998

[Esophageal insufflation test in secondary voice reconstruction].

OBJECTIVE: To restore the alaryengeal patients' enunciation function, reduce operative trauma, increase the accuracy of detecting the success of secondary voice restoration and evaluate objectively the practical clinical significance of esophageal insufflation test. METHODS: Esophageal insufflation test and secondary voice restoration were done for 45 alaryngeal patients, especially those with negative results of esophageal insufflation tests. RESULTS: It showed that the success rate of voice rehabilitation in patients with negative insufflation test but no intact pharyngeal constrictor was 94.7%(36/38), in those with positive insufflation test was 100%(7/7) uniformly. The postoperative pronounciation performance was better than that at the test time. CONCLUSION: Esophageal insufflation test is a useful procedure in predicting the postoperative pronunciation, but could be influenced by many factors, so it can not be used as the only test for estimating the postoperative pronunciation.

Adult↗

PubMed1993

[The effects of anesthetic techniques and insufflating gases on ventilation during laparoscopy].

The present study was performed to clarify the influences of anesthetic methods and insufflating gases on arterial blood gas and ventilation during laparoscopy. Forty five women undergoing laparoscopy for gynecological procedure were studied after dividing into four groups; general anesthesia with control ventilation or epidural anesthesia with spontaneous breathing, plus insufflation with carbon dioxide (CO2) or nitrous oxide (N2O). After CO2 insufflation, PaCO2 increased significantly in the patients who were mechanically ventilated, but not in the patients breathing spontaneously. After N2O insufflation, the decrease in tidal volume (VT) and the increase in VD/VT were significant, but minute ventilation was well maintained by the compensatory increase in respiratory frequency during spontaneous breathing. On the other hand, after CO2 insufflation VE and VD/VT increased significantly without any change in VT. PaO2 decreased significantly after both insufflation and Trendelenburg tilt in all groups, probably secondary to the decrease in functional residual capacity. These findings suggest that during laparoscopy, ventilation could be well maintained by spontaneous breathing, although the increase in VD/VT and costal breathing indicate the increase in respiratory work load. We recommend that ventilation and oxygenation should be closely monitored during laparoscopy to avoid hypercapnia and hypoxia.

Adolescent↗

PubMed1995

Effect of extraperitoneal carbon dioxide insufflation on intraoperative blood gas and hemodynamic changes.

Carbon dioxide pneumoperitoneum has been shown to produce respiratory and hemodynamic changes due to both CO2 absorption and the effects of increased intraperitoneal pressure. We have measured the blood gas, end-tidal CO2, and hemodynamic changes produced during extraperitoneal CO2 insufflation (n = 22). These have been compared with the changes occurring during CO2 pneumoperitoneum (n = 11) under standardized anesthetic conditions. The changes observed during pneumoperitoneum were consistent with previous descriptions. There was a median rise in arterial pCO2 of 1 kPa over the first 15-20 min, followed by a second phase of only gradual change. There was also an increase in mean arterial pressure of 18 mmHg during the insufflation period. We have found a similar magnitude of rise in arterial pCO2 during extraperitoneal insufflation (median 0.83 kPa), but the rate of rise was significantly slower (P < 0.05). In addition, there was no change in the mean arterial pressure during extraperitoneal insufflation. Our results suggest that extraperitoneal CO2 insufflation may be safer than CO2 pneumoperitoneum in patients with preexisting cardiorespiratory disease.

Adult↗

PubMed2001

Hemodynamic responses to intrapleural insufflation with hemipulmonary collapse.

BACKGROUND: The hemodynamic effects of carbon dioxide (CO2) insufflation with hemipulmonary collapse were studied in consecutive thoracoscopic harvests of the left or right internal mammary artery (IMA), which were used for video-assisted coronary artery bypass grafting. METHODS: Thirty-eight patients (30 male, eight female) with a mean age of 69.5 +/- 11.5 years were selected, and 33 left and five right IMA were harvested thoracoscopically. After hemipulmonary collapse was established by single-lung ventilation, low-flow (2-3 L/min) CO2 was delivered at a constant intrapleural pressure of 8-10 mmHg. Using electrocardiography, a radial arterial catheter, a Swan-Ganz catheter, and transesophageal echocardiography, we obtained values for seven hemodynamic variables. Baseline data were collected during bilateral lung ventilation. Each variable was then measured during hemipulmonary collapse and insufflation. The significance of any changes was established with Student's t-test after correcting for baseline differences. RESULTS: Insufflation facilitated IMA harvest by expanding the pleural space between the anterior chest wall and heart. Mean insufflation times were 40.8 +/- 12.2 min on the left and 33.5 +/- 8.5 min on the right. Significant increases from the baseline values were observed in the mean central venous pressure (L:4.7-9.0 mmHg, R: 5.1-14.0 mmHg, p < 0.05), the pulmonary arterial pressure (L: 11.3-17.3 mmHg, R: 12.1-19.9 mmHg, p < 0.05), and the pulmonary capillary wedge pressure (L: 7.2-10.5 mmHg, R: 6.5-10.0 mmHg, p < 0.05). On the right, but not on the left, slight decreases were noted in the mean arterial pressure and cardiac index (71.3-62.6 mmHg, 2.01-1.76 L min-1 m-2, p < 0.05). CONCLUSIONS: The hemodynamic effect resulting from one-lung collapse plus low-flow CO2 insufflation at 8-10 mmHg for 30-40 min is mild in both hemithoraces, although the impact is greater on the right.

Aged↗