title: Cardiovascular and respiratory changes and convalescence in laparoscopic colonic surgery: comparison between carbon dioxide pneumoperitoneum and gasless laparoscopy.
abstract: OBJECTIVE
  Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery.
  
  
  METHODS
  Prospective randomized trial.
  
  
  METHODS
  Department of Surgery in a university hospital.
  
  
  METHODS
  Twenty-two patients scheduled for laparoscopic colonic resection; 5 patients were excluded because of conversion to open surgery (N = 17).
  
  
  METHODS
  Patients were randomized to either gasless (n = 9) or conventional CO2 (n = 8) surgery.
  
  
  METHODS
  Intraoperative assessment of hemodynamic factors and pulmonary function, and postoperative assessment of pain, pulmonary function, convalescence, and various injury factors were done several times until 30 days after surgery. Surgical complications were noted.
  
  
  RESULTS
  Descending aorta blood flow after 30 minutes (P=.03) and heart rate after 150 minutes were higher in the CO2 group (P=.009). Central venous pressure, PaCO2 inspiration pressure, and end tidal CO2 level were significantly higher in the CO2 group (P = .05, .03, .04, and .01, respectively). Patients in the CO2 group had less pain during mobilization and coughing (P = .008 and .006, respectively), and were significantly more fatigued (P = .04). No other important differences were observed in intraoperative hemodynamic factors, postoperative convalescence, immunocompetence, or pulmonary function.
  
  
  CONCLUSIONS
  No clinically important differences in cardiovascular and systemic response were observed between patients undergoing CO2 or gasless laparoscopy for colonic disease.
authors.affiliation: Department of Surgery, Sundby Hospital, Copenhagen, Denmark. svsc@glostruphosp.kbhamt.dk
authors.forename: S
authors.initials: S
authors.lastname: Schulze
authors.forename: K M
authors.initials: KM
authors.lastname: Lyng
authors.forename: K
authors.initials: K
authors.lastname: Bugge
authors.forename: A
authors.initials: A
authors.lastname: Perner
authors.forename: A
authors.initials: A
authors.lastname: Bendtsen
authors.forename: J
authors.initials: J
authors.lastname: Thorup
authors.forename: H J
authors.initials: HJ
authors.lastname: Nielsen
authors.forename: V
authors.initials: V
authors.lastname: Rasmussen
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000008:administration & dosage*; D003106:Colon / Q000601:surgery*; D003289:Convalescence; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial; D011182:Postoperative Care; D011446:Prospective Studies; D012119:Respiration
chemical_list: D002245:Carbon Dioxide