title: Warm, humidified carbon dioxide gas insufflation for laparoscopic appendicectomy in children: a double-blinded randomized controlled trial.
abstract: OBJECTIVE
  To investigate clinical benefits of warm, humidified carbon dioxide (CO(2)) insufflation for acute laparoscopic appendicectomy on postoperative pain and recovery in children (age 8-14 years).
  
  
  BACKGROUND
  Conventional CO(2) insufflation leads to desiccation-related peritoneal inflammation and injury, which is preventable with warm, humidified CO2 gas. We hypothesized that reduced peritoneal desiccation would improve patient-centered outcomes in children after laparoscopic appendicectomy.
  
  
  METHODS
  A double-blinded, randomized controlled trial was conducted. Intervention group participants received warm (37°C), humidified (98% relative humidity) CO(2) gas insufflation, whereas control participants received standard room temperature (20°C) gas with 0% relative humidity. Perioperative analgesia and anesthesia were standardized. Postoperative opiate usage was converted to morphine equivalent daily dosages (MEDD) for comparison, and pain intensity at rest and on moving was rated by participants using visual analog scales. Postoperative recovery and return to normal activities was assessed using a questionnaire on day 10.
  
  
  RESULTS
  Between February 2010 and March 2011, a total of 190 participants were randomized. Both intervention and control groups were matched at baseline. Postoperative MEDD and pain scores were also similar. There were no differences in postoperative recovery parameters.
  
  
  CONCLUSIONS
  Warm, humidified CO(2) insufflation for acute laparoscopic appendicectomy has no short-term clinical benefits on postoperative outcomes in pediatric patients (ClinicalTrials.gov trial identifying code: NCT01027455).
authors: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. wendy.yu@auckland.ac.nz
authors: Tzu-Chieh
authors: TC
authors: Yu
authors: James K
authors: JK
authors: Hamill
authors: Andrew
authors: A
authors: Liley
authors: Andrew G
authors: AG
authors: Hill
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D002648:Child; D002985:Clinical Protocols; D004311:Double-Blind Method; D005260:Female; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D002245:Carbon Dioxide; D009020:Morphine