title: A comparison of the hemodynamic and ventilatory effects of abdominal insufflation with helium and carbon dioxide in young swine.
abstract: Abdominal CO2 insufflation has been shown to cause hypercarbia, acidemia, and decreased oxygenation in a pediatric animal model. Such metabolic derangements have prompted a search for alternative insufflation gases. This study compares the hemodynamic and ventilatory changes that occur during pneumoperitoneum with CO2 and helium. Four juvenile swine were intubated and given general anesthesia. Minute ventilation was adjusted to obtain a baseline Pco2 of between 32 and 36 mm Hg, and was kept constant for the duration of the experiment. The subjects initially were insufflated with CO2 or helium at a pressure of 10 mm Hg. Peak ventilatory pressure, end-tidal CO2 (ETCO2) arterial pH, Pco2, Po2, and right atrial and inferior vena caval pressures were measured before and during a 1-hour insufflation period. After desufflation, Pco2 and pH were restabilized. The same parameters were then measured during reinsufflation with the alternate gas. CO2 insufflation caused significant decreases in pH, from 7.51 +/- 0.03 to 7.32 +/- 0.06, and Po2 increased from 261 +/- 49 to 189 +/- 33 mm Hg. Pco2 increased from 35.0 +/- 1.4 to 57.9 +/- 6.3 mm Hg. ETCO2 also increased, from 29.0 +/- 2.2 to 47.2 +/- 5.0 mm Hg. Helium insufflation caused pH to decrease from 7.51 +/- 0.01 to 7.42 +/- 0.04. Pco2 increased from 32.8 +/- 0.8 to 43.5 +/- 3.9 mm Hg, and ETCO2 increased from 27.8 +/- 0.5 to 36.8 +/- 3.1 mm Hg. These alterations were significantly less than those with CO2 pneumoperitoneum. Po2 decreased as well-from 266 +/- 30 to 212 +/- 21 mm Hg. During insufflation with both gases, peak ventilatory pressure and right atrial pressure increased significantly. Abdominal insufflation with CO2 or helium causes hypercarbia, acidemia, and increased ETCO2 in this juvenile animal model. These derangements are significantly less with helium. This gas may prove to be the more suitable insufflation agent for pediatric patients.
authors.affiliation: Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Liem
authors.forename: M
authors.initials: M
authors.lastname: Krishnamoorthy
authors.forename: H
authors.initials: H
authors.lastname: Applebaum
authors.forename: R
authors.initials: R
authors.lastname: Kolata
authors.forename: R G
authors.initials: RG
authors.lastname: Rudd
authors.forename: W
authors.initials: W
authors.lastname: Chen
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000818:Animals; D002245:Carbon Dioxide / Q000097:blood / Q000494:pharmacology*; D006371:Helium / Q000097:blood / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D010535:Laparoscopy / Q000379:methods; D010313:Partial Pressure; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D015656:Respiratory Mechanics / Q000187:drug effects*; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D006371:Helium