Warm CO2 insufflation for laparoscopic surgery

Abstract

Laparoscopic surgery has gained wide acceptance for abdominal hernioplasty. We have found problems in urinary output when room temperature CO2 is insufflated. We, therefore, evaluated the consequences of room temperature and warm CO2 insufflation for pneumoperitoneum. Twenty-eight patients undergoing laparoscopic surgery or transabdominal inguinal hernioplasty were randomly allocated to receive either cool (21°C) CO2 (CI group) or warm (37°C) CO2 (WI group) for insufflation (I). After standardized anaesthesia induction pulmonary and radial artery and urinary catheters were inserted. Intravascular volume loading was carried out with Ringer's acetated solution and hydroxyethylstarch. Haemodynamic measurements, pulmonary artery temperature and urine output were recorded perioperatively. If urine excretion did not achieve 1 mL kg−1 15% mannitol 100 mL was administered. The groups were comparable in age, weight, total amount of CO2, volume loading and duration of operation. Haemodynamic changes were similar in the two groups. Eleven patients in the CI group and three in the WI group required mannitol during surgery (P<0.01). At 60 min of insufflation the cumulative diuresis was smaller in the CI group than in the WI group (Table 6). Mean (SD).Table 6: (abstract 17). Effects of cool or warm carbon dioxide insufflation on core temperature, cumulative diuresis and shivering During the recovery room period five patients in the CI group suffered shivering (P<0.05). The central temperature of these patients was 0.6°C lower than that of other patients in the CI group. The difference in the central temperature between the groups was about 0.5°C at the end of insufflation. Although the central temperature did not decrease significantly during surgery the diuresis declined in the majority of the patients in the CI group. This may be due to renal vasoconstriction associated with cool intra-abdominal CO2. Vasopressin is activated during cool insufflation [1]. This may be deleterious for patients with compromised renal function.