Measurement of CO(2) hypothermia during laparoscopy and pelviscopy: how cold it gets and how to prevent it.
OBJECTIVE
To evaluate intraabdominal CO(2) temperature during a variety of standard operative laparoscopy procedures with different insufflators (BEI Medical, Snowden & Pencer, Storz Laparoflator, Storz Endoflator, Wolf) and devices to maintain body temperature (Bair Hugger, fluid warmer, Blanketrol blankets).


METHODS
Prospective, nonrandomized study (Canadian Task Force classification II-1).


METHODS
Community hospital in rural Alabama.


METHODS
Sixty-two consecutive patients (53 women, 9 men; average age 56.8 yrs, range 21-94 yrs).


METHODS
Patients underwent standard laparoscopic and pelviscopic procedures during which intraoperative temperature changes in the insufflation system, abdomen, and rectum were measured.


RESULTS
Carbon dioxide was at room temperature in the insufflation hose ( approximately 23 degrees C). During insufflation, intraabdominal gas temperature decreased to as much as 27.7 degrees C (average 32.7 degrees C) depending on length of operation (23 min-5 hrs 8 min), amount of gas used (12.8-801 L), gas flow (up to 20 L/min), and leakage rate. Preoperative and postoperative temperature comparisons showed no decline in rectal temperature (average +0.18 degrees C) because warming equipment was sufficient.


CONCLUSIONS
The decrease in intraoperative intraabdominal gas temperature is remarkable and can potentially harm the patient. It can be limited by restricting gas flow and leakage. In operations longer than 1 hour, substantial core body temperature drop should be prevented with appropriate heating and hydration devices. An insufflator with internal gas heating (Snowden & Pencer) had no significant clinical effect. (J Am Assoc Gynecol Laparosc 6(3):289-295, 1999)
Jacobs
V R
VR
Department of Surgery, Fayette Medical Center, Alabama, USA.
Morrison
J E
JE
Mettler
L
L
Mundhenke
C
C
Jonat
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
D002245:Carbon Dioxide