title: Beneficial effects of humidified, warmed carbon dioxide insufflation during laparoscopic bariatric surgery: a randomized clinical trial.
abstract: BACKGROUND
  Recent data has shown that the use of warmed, humidified carbon dioxide (CO2) insufflation during laparoscopic surgery may be associated with better outcomes.
  
  
  METHODS
  We performed a randomized, doubleblind, prospective controlled clinical trial of 30 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP). Patients were randomized into 2 groups. The first group (group 1, n=15) received standard (dry, room temperature) CO2 for insufflation during the surgery, while the second group (group 2, n=15) received warmed (35 degrees C) and humidified (95%) CO2. Patients received postoperative analgesia from morphine delivered via a patient-controlled analgesia (PCA) pump. Pain scores (on a scale of 0 to 10, 0 being no pain and 10 being the worst pain) were measured postoperatively at 3 h, 6 h, 1 day and 2 days. The amount of morphine that was delivered through the PCA was also measured at the same time intervals. Operating-room (OR) time, core temperature, and total hospital length of stay were documented.
  
  
  RESULTS
  Postoperative pain as documented by pain scores and narcotic usage were not statistically different in the 2 groups. We demonstrated a statistically significant difference (mean+/-SD) in OR time (76+/-16 min vs 101+/-34 min, P=0.02), total hospital length of stay (3.2+/-.4 days vs 4.0+/-.9 days, P=0.01) and end-of-case core temperature (36.2+/-.5 degrees C vs 35.7+/-.6 degrees C, P=0.02) in group 2 compared with group 1.
  
  
  CONCLUSIONS
  The use of warmed, humidified CO2 insufflation in bariatric patients undergoing LRYGBP was not associated with any significant benefit with regards to postoperative pain.
authors.affiliation: Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA. rhsavel@yahoo.com
authors.forename: Richard H
authors.initials: RH
authors.lastname: Savel
authors.forename: Shyamasundar
authors.initials: S
authors.lastname: Balasubramanya
authors.forename: Samy
authors.initials: S
authors.lastname: Lasheen
authors.forename: Teimuraz
authors.initials: T
authors.lastname: Gaprindashvili
authors.forename: Eddie
authors.initials: E
authors.lastname: Arabov
authors.forename: Rafael M
authors.initials: RM
authors.lastname: Fazylov
authors.forename: Richard S
authors.initials: RS
authors.lastname: Lazzaro
authors.forename: Jerzy M
authors.initials: JM
authors.lastname: Macura
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D002245:Carbon Dioxide / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006813:Humidity; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D010149:Postoperative Pain / Q000503:physiopathology; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation* / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013696:Temperature; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide