Heating and humidifying of carbon dioxide during pneumoperitoneum is not indicated: a prospective randomized trial. Surg Endosc 2006 Jan;20(1):153-8
Date
12/08/2005Pubmed ID
16333546DOI
10.1007/s00464-005-0271-xScopus ID
2-s2.0-30744461613 (requires institutional sign-in at Scopus site) 37 CitationsAbstract
BACKGROUND: Carbon dioxide (CO2) pneumoperitoneum usually is created by a compressed gas source. This exposes the patient to cool dry gas delivered at room temperature (21 degrees C) with 0% relative humidity. Various delivery methods are available for humidifying and heating CO2 gas. This study was designed to determine the effects of heating and humidifying gas for the intraabdominal environment.
METHODS: For this study, 44 patients undergoing laparoscopic Roux-en-Y gastric bypass were randomly assigned to one of four arms in a prospective, randomized, single-blinded fashion: raw CO2 (group 1), heated CO2 (group 2), humidified CO2 (group 3), and heated and humidified CO2 (group 4). A commercially available CO2 heater-humidifier was used. Core temperatures, intraabdominal humidity, perioperative data, and postoperative outcomes were monitored. Peritoneal biopsies were taken in each group at the beginning and end of the case. Biopsies were subjected staining protocols designed to identify structural damage and macrophage activity. Postoperative narcotic use, pain scale scores, recovery room time, and length of hospital stay were recorded. One-way analysis of variance (ANOVA) and the nonparametric Kruskal-Wallis test were used to compare the groups.
RESULTS: Demographics, volume of CO2 used, intraabdominal humidity, bladder temperatures, lens fogging, and operative times were not significantly different between the groups. Core temperatures were stable, and intraabdominal humidity measurements approached 100% for all the patients over the entire procedure. Total narcotic dosage and pain scale scores were not statistically different. Recovery room times and length of hospital stay were similar in all the groups. Only one biopsy in the heated-humidified group showed an increase in macrophage activity.
CONCLUSIONS: The intraabdominal environment in terms of temperature and humidity was similar in all the groups. There was no significant difference in the intraoperative body temperatures or the postoperative variable measured. No histologic changes were identified. Heating or humidifying of CO2 is not justified for patients undergoing laparoscopic bariatric surgery.
Author List
Davis SS, Mikami DJ, Newlin M, Needleman BJ, Barrett MS, Fries R, Larson T, Dundon J, Goldblatt MI, Melvin WSAuthor
Matthew I. Goldblatt MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AbdomenAdult
Analgesics, Opioid
Body Temperature
Carbon Dioxide
Dose-Response Relationship, Drug
Gastric Bypass
Hot Temperature
Humans
Humidity
Length of Stay
Middle Aged
Morphine
Pain Measurement
Peritoneum
Pneumoperitoneum, Artificial
Recovery Room
Single-Blind Method
Time Factors