Cardiorespiratory effects of laparoscopy with and without gas insufflation.
BACKGROUND
Patients who are undergoing laparoscopic procedures can present with a number of ventilatory and circulatory problems. The use of a gasless technique for performing a laparoscopy by using a mechanical lifting device may potentially avoid such problems.


OBJECTIVE
To compare the cardiorespiratory effects of laparoscopy with and without gas insufflation.


METHODS
Twelve adult pigs were randomized to undergo a laparoscopy by using either carbon dioxide insufflation or mechanical elevation. Full invasive monitoring was performed preoperatively and at 10-minute intervals throughout the operative period. Parameters that were measured included blood gas determinations, mean arterial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output, stroke volume, and total peripheral resistance.


RESULTS
Carbon dioxide insufflation unlike mechanical elevation led to a fall in PO2 and absorption of a significant quantity of CO2, resulting in hypercapnia, acidosis, and a consequent hyperdynamic circulation.


CONCLUSIONS
These findings have significant implications for the use of CO2 insufflation for laparoscopy in patients with a compromised respiratory or cardiac status.
McDermott
J P
JP
Medical Center of Central Massachusetts, Worcester, USA.
Regan
M C
MC
Page
R
R
Stokes
M A
MA
Barry
K
K
Moriarty
D C
DC
Caushaj
P F
PF
Fitzpatrick
J M
JM
Gorey
T F
TF
D000818:Animals; D006439:Hemodynamics; D010535:Laparoscopy / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D011659:Pulmonary Gas Exchange; D011897:Random Allocation; D013552:Swine; D014692:Ventilation-Perfusion Ratio