title: Intra-operative tissue oxygen tension is increased by local insufflation of humidified-warm CO2 during open abdominal surgery in a rat model.
abstract: BACKGROUND
  Maintenance of high tissue oxygenation (PtO2) is recommended during surgery because PtO2 is highly predictive of surgical site infection and colonic anastomotic leakage. However, surgical site perfusion is often sub-optimal, creating an obstructive hurdle for traditional, systemically applied therapies to maintain or increase surgical site PtO2. This research tested the hypothesis that insufflation of humidified-warm CO2 into the abdominal cavity would increase sub-peritoneal PtO2 during open abdominal surgery.
  
  
  METHODS
  15 Wistar rats underwent laparotomy under general anesthesia. Three sets of randomized cross-over experiments were conducted in which the abdominal cavity was subjected to alternating exposure to 1) humidified-warm CO2 & ambient air; 2) humidified-warm CO2 & dry-cold CO2; and 3) dry-cold CO2 & ambient air. Sub-peritoneal PtO2 and tissue temperature were measured with a polarographic oxygen probe.
  
  
  RESULTS
  Upon insufflation of humidified-warm CO2, PtO2 increased by 29.8 mmHg (SD 13.3; p<0.001), or 96.6% (SD 51.9), and tissue temperature by 3.0°C (SD 1.7 p<0.001), in comparison with exposure to ambient air. Smaller, but significant, increases in PtO2 were seen in experiments 2 and 3. Tissue temperature decreased upon exposure to dry-cold CO2 compared with ambient air (-1.4°C, SD 0.5, p = 0.001).
  
  
  CONCLUSIONS
  In a rat model, insufflation of humidified-warm CO2 into the abdominal cavity during open abdominal surgery causes an immediate and potentially clinically significant increase in PtO2. The effect is an additive result of the delivery of CO2 and avoidance of evaporative cooling via the delivery of the CO2 gas humidified at body temperature.
authors.affiliation: Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia; Graduate School of Medicine, University of Wollongong, Wollongong, Australia.
authors.forename: Jean K
authors.initials: JK
authors.lastname: Marshall
authors.affiliation: Karolinska Institute, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lindner
authors.affiliation: Moruya District Hospital, Moruya, Australia.
authors.forename: Noel
authors.initials: N
authors.lastname: Tait
authors.affiliation: Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
authors.forename: Tracy
authors.initials: T
authors.lastname: Maddocks
authors.affiliation: School of Women's & Children's Health, University of New South Wales, Sydney, Australia.
authors.forename: Angelique
authors.initials: A
authors.lastname: Riepsamen
authors.affiliation: Karolinska Institute, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Linden
mesh_terms: D000818:Animals; D001831:Body Temperature; D002245:Carbon Dioxide / Q000008:administration & dosage*; D005260:Female; D006813:Humidity; D007432:Intraoperative Period; D007813:Laparotomy / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
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