Heated CO(2) with or without humidification for minimally invasive abdominal surgery.
BACKGROUND
Intraoperative hypothermia during both open and laparoscopic abdominal surgery may be associated with adverse events. For laparoscopic abdominal surgery, the use of heated insufflation systems for establishing pneumoperitoneum has been described to prevent hypothermia. Humidification of the insufflated gas is also possible. Past studies have shown inconclusive results with regards to maintenance of core temperature and reduction of postoperative pain and recovery times.


OBJECTIVE
To determine the effect of heated gas insufflation on patient outcomes following minimally invasive abdominal surgery.


METHODS
The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (PubMed), EMBASE, International Pharmaceutical Abstracts (IPA), Web of Science, Scopus, www.clinicaltrials.gov and the National Research Register were searched (1956 to 14 June 2010). Grey literature and cross-references were also searched. Searches were limited to human studies without language restriction.


METHODS
All included studies were randomized trials comparing heated (with or without humidification) gas insufflation with cold gas insufflation in adult and pediatric populations undergoing minimally invasive abdominal procedures. Study quality was assessed in regards to relevance, design, sequence generation, allocation concealment, blinding, possibility of incomplete data and selective reporting. The selection of studies for the review was done independently by two authors, with any disagreement resolved in consensus with a third co-author.


METHODS
Screening of eligible studies, data extraction and methodological quality assessment of the trials were performed by the authors. Data from eligible studies were collected using data sheets. Results were presented using mean differences for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes. The estimated effects were calculated using the latest version of RevMan software. Publication bias was taken into consideration and funnel plots were compiled.


RESULTS
Sixteen studies were included in the analysis. During laparoscopic abdominal surgery, no effect on postoperative pain nor changes in core temperature, morphine consumption, length of hospitalisation, lens fogging, length of operation or recovery room stay were associated with heated compared to cold gas insufflation with or without humidification.


CONCLUSIONS
The study offers evidence that during laparoscopic abdominal surgery, heated gas insufflation, with or without humidification, has minimal benefit on patient outcomes.
Center for the Advancement of Minimally Invasive Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada, T5H 3V9.
Daniel W
DW
Birch
Namdar
N
Manouchehri
Xinzhe
X
Shi
Ghassan
G
Hadi
Shahzeer
S
Karmali
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001831:Body Temperature; D002245:Carbon Dioxide; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D006813:Humidity; D007035:Hypothermia / Q000517:prevention & control*; D007327:Insufflation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid; D002245:Carbon Dioxide; D009020:Morphine