Effects Of CO2 Insufflation Research Articles

Expanding safety boundaries in pediatric robotic-assisted laparoscopic surgery: are we protecting our children?

Little is known about the effects of CO2 insufflation (CDI) on cerebral oxygen saturation (CrSO2) during laparoscopy in the pediatric population. In children undergoing robotic-assisted laparoscopic pyeloplasty (RALP), we prospectively assessed the effects of CDI using standard monitoring and cerebral near-infrared spectroscopy (NIRS). We also explored whether a correlation existed between CrSO2 and parameters known to affect cerebral blood flow. Between January 2021 and September 2023, a cohort of consecutive children older than 2years underwent RALP at Necker-Enfants Malades Hospital in Paris. A ventilation protocol aimed to prevent hypercarbia was implemented. Data collected included standard monitoring parameters and CrSO2 by NIRS. Thirty patients (16 females), mean age 5.5 ± 3.9 (2.0-9.5) years, were included. Twenty-three patients underwent a retroperitoneal approach. The mean baseline CrSO2 value was 83.0 ± 9.8. Mean CrSO2 decreased during progressive CDI, never below baseline values, while standard-monitoring parameters did not significantly change. No significant correlation was detected between CrSO2 and end tidal CO2, or between CrSO2 and mean arterial pressure, at any operative time. During RALP, a gradual CDI doesn't cause pathological derangements of CrSO2. The lack of correlation between CrSO2 and standard parameters affecting cerebral blood flow suggests the likely presence of cerebral autoregulation in our population.

End tidal CO2 level (PETCO2) during laparoscopic surgery: comparison between spinal anaesthesia and general anaesthesia

Background: Laparoscopy is a procedure which involves insufflations of the abdomen by a gas, so that endoscope can visualise intra abdominal content without being in direct contact with viscera or tissues. Its advantages are small incisions, less pain, less postoperative ileus, short hospital stay compared to traditional open method. Monitoring of end tidal carbon dioxide (PETCO2) and hemodynamics is very necessary during Laparoscopy surgery. This study is conducted to find out effects of CO2 insufflation on parameters like PETCO2, Mean arterial pulse pressure, SPO2 under spinal anaesthesia and general anaesthesia in ASA I and ASA II patients.Methods: The present study was conducted in the department of anaesthesiology from December 2014 to September 2015.This study was a prospective, randomized controlled, single blind. Each group consisted of 30 patients having Group A and Group B as patient undergoing laparoscopic surgery under Spinal anaesthesia and General anaesthesia respectively. Preoperatively patients in Group A (Spinal anaesthesia) given inj. Midazolam 0.3mg/kg IM 45 before surgery and Group B (General anaesthesia) inj. pentazocin 0.3mg/kg, inj. promethazine 0.5mg/kg, inj. Glycopyrrolate 0.004 mg/kg IM 45 before surgery. In operation theatre, intra operative pulseoximetre, ECG, SPO2, Heart rate (HR), Mean arterial pulse pressure and PETCO2 monitoring done. Amount of CO2 insufflated noted.Results: It was found from present study that in both group there was significant progressive rise in PETCO2 after CO2 insufflation, with peak at 30 min and thereafter plateau till the end of procedure (avg. duration 45-60 min). In group A i.e. laparoscopic surgery under spinal anaesthesia with (spontaneous respiration) the rise in PETCO2 was significant as compared to the group B i.e. laparoscopic surgery under general anaesthesia with controlled ventilation. The heart rate increased after CO2 insufflation in both the group, but it was significant in group A. The increase in SBP, DBP, MAP were less in group A as compared to group B. SPO2 showed no significant changes and it remained above 97% in all patients throughout surgery. All values come to baseline 15 min after insufflation.Conclusions: From the present study it can be concluded that balanced general anaesthesia using IPPV with moderate hyperventilation, as the preferred anaesthetic technique for laparoscopic surgery.

Does carbon dioxide insufflation impact adenoma detection rate? A single-center retrospective analysis.

Background and study aims: Carbon dioxide (CO2) has been associated with reduced post-procedural pain and improved patient satisfaction when compared to air insufflation (AI). The effect of CO2 insufflation (CO2I) on the adenoma detection rate (ADR) remains unclear. The aims of this study are to compare ADR in patients undergoing screening colonoscopy with AI vs. CO2I and identify predictors of ADR. Patients and methods: Single-center retrospective cohort study of 2,107 patients undergoing screening colonoscopy at the University of Florida Hospital between November 2011 and June 2015. Patient demographics, procedural parameters, and histology results were retrospectively obtained from a prospectively maintained colonoscopy database. Univariate and multivariate analysis were performed to identify predictors of ADR. Results: A total of 2107 colonoscopies (644 with AI and 1463 with CO2I) were analyzed. Overall ADR was 27.8 %. There was no significant difference in ADR between AI (27.6 %) vs. CO2I (27.8 %) (P = 0.93). Method of insufflation (AI vs. CO2I) was not significantly associated with ADR (OR 0.9; 95 % CI:0.7 – 1.2). Older age (OR: 1.02; 95 % CI: 1.001 – 1.03 per year increase), male gender (OR 1.48; 95 % CI: 1.17 – 1.87), and longer scope withdraw time (OR 1.13; 95 % CI: 1.1 – 1.16 per minute) were associated with a higher ADR. Fellow involvement was negatively associated with ADR (OR 0.60; 95 % CI: 0.47 – 0.77). Conclusion: ADR was similar between patients who underwent screening colonoscopy with AI vs. CO2I. While CO2I has been associated with improved patient comfort and post-procedural recovery time, there is no definitive evidence to suggest that this method of luminal distention enhances ADR.

P-30: The Effects of Co2-Insufflation with 5 and 10 MMHG During Thoracoscopy on Cerebral Oxygenation and Hemodynamics in Piglets

P-30: The Effects of Co2-Insufflation with 5 and 10 MMHG During Thoracoscopy on Cerebral Oxygenation and Hemodynamics in Piglets

Autonomic nervous responses in colorectal polypectomy: Randomized controlled trial comparing air and carbon dioxide insufflation.

Carbon dioxide (CO2) insufflation devices are commonly used for endoscopic examination and treatment. In this prospective randomized controlled trial (RCT), we compared patient acceptance, cardiovascular tolerance,and autonomic nervous responses between patients receiving air insufflation and CO2 insufflation. We initially enrolled 170 patients and, of these, 158 patients in total were analyzed (air group, 83; CO2 group, 75). Autonomic nervous responses were evaluated by analysis of heart rate variability (HRV). Primary end point was superiority in the effects of CO2 insufflation on the autonomic nervous system by HRV analysis. Visual analog scale disclosed significantly less abdominal pain and abdominal fullness with CO2. Percentage heart rate change rate at 1 h and 4 h after the procedure was also significantly lower in the CO2 group than in the air group (1 h after: P < 0.01, 4 h after: P < 0.05). Comparison based on age showed that % heart rate change was significantly lower in the younger CO2 patients (just after colonoscopy and 1 h after: P < 0.01, 4 h after: P < 0.05), but this difference was not apparent in an older group of patients. This is the first RCT showing that colorectal polypectomy using CO2 insufflation significantly decreases abdominal pain and abdominal fullness common in such patients with lowered stress to the autonomous nervous system. The effects using CO2 insufflation on the sympathetic nervous system also seemed to be more prominent among younger patients.

Computed Tomography Determined Changes in Position of the Hepatobiliary and Gastrointestinal Systems after CO2 Insufflation to Determine Optimal Positioning for Abdominal Laparoscopy.

To evaluate changes in body position and effect of CO2 insufflation on the hepatobiliary and gastrointestinal systems using computed tomography (CT) to determine optimal laparoscopic approach. Experimental study. Healthy intact female Beagles (n = 6) of similar age, weight, and body condition score. Urinalysis, peripheral blood smear, and abdominal ultrasonography were performed to determine dog health. A series of pre insufflation (PrI) CT scans in ventrodorsal routine (VDR), ventrodorsal Trendelenburg (VDT), left lateral (LL), and right lateral (RL) recumbency were performed before and after abdominal insufflation (PoI) with CO2 (10-14 mm Hg). Pre-determined measurements were made on PrI and PoI scans and differences compared. Liver position was affected by body position and under gravitational influence moved to the dependent part of the abdominal cavity. The gallbladder was best exposed in LL. Stomach position was not significantly changed after insufflation. Different areas of small intestine were dependent on gravitational effects. The pancreas maintained a similar position after insufflation. VDR was the ideal position for all laparoscopic procedures of the liver. The LL position could be used for surgery of the gallbladder but likely provides poor exposure to the rest of the liver. In approaching the stomach and intestines, the area of interest should be used to determine the best position.

The Effect of CO2 Insufflation on Ovarian Tissue Injury and Apoptosis during Laparoscopy: A Rat Model

The Effect of CO2 Insufflation on Ovarian Tissue Injury and Apoptosis during Laparoscopy: A Rat Model

Cerebral blood flow velocity alterations, under two different carbon dioxide management strategies, during sevoflurane anesthesia in gynecological laparoscopic surgery

In this study, 33 female patients, scheduled for operative gynecological laparoscopies, were enrolled. Our aim was prospective, randomized comparison of the influence of two different management strategies, regarding end tidal CO2, on cerebral blood flow velocities and on pulsatility index, examined by means of transcranial Doppler ultrasonography, under sevoflurane anesthesia 1.3 MAC: permissive hypercapnia (up to 45 mmHg, Group I, n = 17) versus intervention to ensure mild hypocapnia, (around 33 mmHg, Group II, n = 16). Baseline measurements of investigated parameters were recorded and CO2 insufflation started. In Group I no further adjustment was performed and CO2 partial pressure rose, while in Group II it was kept stable, by ventilatory patterns adjustment. Hemodynamic, acid base balance and cerebrovascular variables were recorded during pneumoperitoneum and in post-desufflation period, at eight checking time points. In Group I cerebral blood flow velocities increased according to CO2 elevation (2.3%-3.9% per mmHg of increase in CO2 partial pressure), whereas in Group II no significant alterations were noticed. Pulsatility index was constant over time without clinical differences between groups. Our study suggests that under sevoflurane anesthesia 1.3 MAC, prophylactic hyperventilation limits the cerebral blood flow velocities enhancing effect of CO2 insufflation, during laparoscopies.

Tumour implantation following laparoscopy using different insufflation gases.

Because of the possibility of intraperitoneal seeding and port-site recurrences following laparoscopic surgery, the role of laparoscopy in cancer surgery remains controversial. Previous experimental studies have suggested that chemical, metabolic and immunological changes following carbon dioxide (CO2) insufflation may be responsible for this phenomenon. Earlier experimental studies done by the University of Adelaide Department of Surgery have also shown that helium insufflation is associated with none of the adverse changes brought about by CO2 insufflation. Helium insufflation is also associated with lower rates of intra-abdominal tumour spread. The aim of this study was to determine whether these identified benefits apply to inert gases in general. Twenty-four Dark Agouti rats were randomized to undergo laparoscopy with 40 min insufflation using one of the following four gases (six rats in each group); CO2, helium, argon and nitrogen. A tumour cell suspension was injected into the abdominal cavity at the beginning of laparoscopy. The rats were killed 7 days after surgery, and the peritoneal cavity and port sites were examined for the presence of tumour. Rats undergoing helium insufflation, had the least number of port-site recurrences and the least amount of intraperitoneal tumour spread. Argon and nitrogen pneumoperitoneum were associated with a large number of port-site recurrences and widespread tumour seeding. The effect of CO2 insufflation was intermediate. The choice of insufflation gas influences the incidence of port-site metastases and the degree of intraperitoneal tumour spread following laparoscopic cancer surgery. The reduced port-site recurrences and intraperitoneal spread that followed helium pneumoperitoneum is likely to be a unique property of this gas rather than a property of inert gases in general.

The Effects of CO2 Insufflation on Jugular Bulb Venous Blood Oxygen Saturation during Thoracoscopy

The Effects of CO2 Insufflation on Jugular Bulb Venous Blood Oxygen Saturation during Thoracoscopy

The Effect of CO2 Insufflation and Trendelenburg-lithotomy Position on Intraocular Pressure during Laparoscopy

The Effect of CO2 Insufflation and Trendelenburg-lithotomy Position on Intraocular Pressure during Laparoscopy