Circulatory and Respiratory Complications of Carbon Dioxide Insufflation

Abstract

Background: Although providing excellent outcome results, laparoscopy also induces particular pathophysiological changes in response to pneumoperitoneum. Knowledge of the pathophysiology of a CO₂ pneumoperitoneum can help minimize complications while profiting from the benefits of laparoscopic surgery without concerns about its safety. Methods: A review of articles on the pathophysiological changes and complications of carbon dioxide pneumoperitoneum as well as prevention and treatment of these complications was performed using the Medline database. Results: The main pathophysiological changes during CO₂ pneumoperitoneum refer to the cardiovascular system and are mainly correlated with the amount of intra-abdominal pressure in combination with the patient’s position on the operating table. These changes are well tolerated even in older and more debilitated patients, and except for a slight increase in the incidence of cardiac arrhythmias, no other significant cardiovascular complications occur. Although there are important pulmonary pathophysiological changes, hypercarbia, hypoxemia and barotraumas, they would develop rarely since effective ventilation monitoring and techniques are applied. The alteration in splanchnic perfusion is proportional with the increase in intra-abdominal pressure and duration of pneumoperitoneum. Conclusion: A moderate-to-low intra-abdominal pressure (<12 mm Hg) can help limit the extent of the pathophysiological changes since consecutive organ dysfunctions are minimal, transient and do not influence the outcome.

Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats

“…Both groups subjected to PP exhibited oliguria, an effect repeatedly reported in previous studies [4][5][6][7][8][9][10][11]16 . No difference was observed regardless of whether CO 2 or helium was used for insufflation.…”

“…Laparoscopic access, in turn, is associated with decreased pain, lower morbidity, superior cosmesis, shorter postoperative stay and return to preoperative activities as compared with open techniques [2][3][4][5] . Carbon dioxide (CO 2 ) is the gas employed most widely for insufflation, given that it is noncombustible, relatively inexpensive and highly soluble in blood, minimizing the risk of embolism [2][3]6 . However, PP increases intra-abdominal pressure, which has been shown to produce oliguria and renal dysfunction in both animal and clinical studies [1][2][4][5][6][7][8][9][10][11][12] .…”

“…Carbon dioxide (CO 2 ) is the gas employed most widely for insufflation, given that it is noncombustible, relatively inexpensive and highly soluble in blood, minimizing the risk of embolism [2][3]6 . However, PP increases intra-abdominal pressure, which has been shown to produce oliguria and renal dysfunction in both animal and clinical studies [1][2][4][5][6][7][8][9][10][11][12] . In healthy young patients, these changes tend to be mild and reversible due to the various physiologic mechanisms for CO 2 buffering and elimination 2,12 .…”

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

“…This is probably caused by basal atelectasis, a residual cephalad displacement of the diaphragm and restriction in diaphragmatic mobility. 18 Brachial plexus injury due to prolonged caudad displacement of the shoulders is a possible complication of robotic prostatectomy positioning 19 and is of special concern. The use of a support system which limits this caudad pressure on the shoulders (because part of the patient's weight is supported by the spinal column) may prevent patients from developing brachial plexus injuries.…”

Diagnostic value of mini-laparoscopy in patients with abdominal neoplasm

“…Residual carbon dioxide in pneumoperitoneum is cleared more rapidly than other gases, minimizing the duration of postoperative discomfort [12] ; however, the chief drawback of carbon dioxide is its significant vascular absorption across the peritoneum, leading to hypercapnia and intravascular embolization [13] . The mini-laparoscopy technique also exhibited a low demand on the associated artificial pneumoperitoneum.…”