title: Calibrated pneumoperitoneal venting to prevent N2O accumulation in the CO2 pneumoperitoneum during laparoscopy with inhaled anesthesia: an experimental study in pigs.
abstract: Nitrous oxide (N2O) accumulates in the CO2 pneumoperitoneum during laparoscopy when N2O is used as an adjuvant for inhaled anesthesia. This may worsen the consequences of gas embolism and introduce a fire risk. In this study, we quantified the pneumoperitoneal gas venting necessary to prevent significant contamination by inhaled N2O. Four domestic pigs (26-30 kg) were anesthetized and ventilated with 66% N2O in oxygen. A CO2 pneumoperitoneum was insufflated and maintained at a pressure of 12 mm Hg. Each animal underwent three experimental conditions, in random sequence, for 70 min each: 1) no pneumoperitoneal leak, 2) leak of 2 L every 10 min (12 L/h), and 3) leak of 4 L every 10 min (24 L/h). Every 10 min, pneumoperitoneal gas samples were analyzed for fractions (FPn) of N2O and CO2. Without leaks, FPnN2O increased continually and reached 29.58% +/- 3.15% at 70 min. With leaks of 2 and 4 L every 10 min (12 and 24 L/h), FPnN2O reached a plateau of <10% after 30 min. We conclude that calibrated pneumoperitoneal venting of 12 or 24 L/h is enough to prevent the constitution of potentially dangerous pneumoperitoneal gas mixtures if venting is constant.
  
  
  CONCLUSIONS
  External venting calibrated at four or eight initial pneumoperitoneal volumes per hour with compensation by fresh CO2 is sufficient to prevent nitrous oxide buildup of more than 10% in the pneumoperitoneum during laparoscopy with inhaled general anesthesia if venting is constant.
authors.affiliation: Département d'Anesthésiologie, I.R.C.A.D., Hôpitaux Universitaires, Strasbourg, France.
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Diemunsch
authors.forename: Thomas
authors.initials: T
authors.lastname: Van Dorsselaer
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Torp
authors.forename: Roland
authors.initials: R
authors.lastname: Schaeffer
authors.forename: Bernard
authors.initials: B
authors.lastname: Geny
mesh_terms: D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000493:pharmacokinetics*; D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004058:Diffusion; D010535:Laparoscopy; D009609:Nitrous Oxide / Q000493:pharmacokinetics*; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D013552:Swine
chemical_list: D018685:Anesthetics, Inhalation; D002245:Carbon Dioxide; D009609:Nitrous Oxide