Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery

Abstract

Purpose: Some studies have reported that warmed humidified carbon dioxide (CO 2 ) insufflation in adult laparoscopic surgery could reduce pain and improve the core body temperature (CBT). However, similar studies are lacking in infants. Thus, this study aimed to investigate the clinical effects of warmed, humidified CO 2 insufflation in pediatric patients undergoing major laparoscopic surgeries. Methods: From January 2015 to December 2017, infants who underwent major laparoscopic surgeries in Ningbo Women and Children's Hospital were randomized to Group A (standard CO 2 insufflation) or Group B (warmed humidified CO 2 insufflation, 35°C, 95% relative humidity). Change in CBT at the end of surgery was the primary outcome. Secondary outcomes included surgery time, intraoperative blood loss, oxygen saturation (SO 2 ), and Face, Legs, Activity, Cry and Consolability (FLACC) scale. These variables were compared between the 2 groups. Results: Sixty-three infants (38 females, 25 males) were included; 30 patients were in Group A and 33 in Group B. The diseases treated with the laparoscopic approach included congenital megacolon, congenital diaphragmatic hernia, and intestinal malrotation. No deaths were noted. CBT was significantly higher in Group B at the end of surgery ( P = .021). The occurrence of postoperative shivering ( P = .02), hypothermia ( P = .032), bowel movement ( P = .044), and hospital stay ( P = .038) was significantly different between the 2 groups; Group B had less shivering and hypothermia occurrence after surgery. Moreover, Group B demonstrated a more rapid postoperative recovery of bowel movement and shortened hospital stay than Group A. There was no statistical difference in operative time ( P = .162), intraoperative blood loss ( P = .541), SO 2 ( P = .59), and FLACC scale ( P = .65) between the 2 groups. Conclusion: The use of warmed humidified CO 2 insufflation in infants undergoing major laparoscopic surgery was helpful for maintaining normothermia and was associated with several positive postoperative outcomes, including less shivering and hypothermia, faster recovery of bowel movement, and shortened hospital stay.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial

“…Last but not least, a study conducted on pediatric patients who had undergone laparoscopic surgery demonstrated that heated and humidified CO2 insufflation better maintained the internal temperature than standard CO2 insufflation. They also propounded positive postoperative outcomes, such as reduced shivering and shorter hospital stays for patients [ 9 , 17 ]. Of note, pediatric cases face more significant challenges in maintaining their body temperature and are at a higher risk of hypothermia compared to adults.…”

“…However, alterations in temperature due to carbon dioxide (CO2) insufflation during laparoscopic surgeries appear [2][3][4][5][6]. In addition, warming and humidification of insufflated CO2 gas have been reported in order to reduce the development of hypothermia [7][8][9][10][11].…”

Prevention of hypothermia in newborn submitted to surgical procedures: an integrative review

“…Two articles (11,26) compared the performance of a surgical procedure in different environments (Operating Room (OR) and Neonatal Intensive Care Unit (NICU)) and evaluated where there was a higher incidence of hypothermia in the NBs; another (25) analyzes the OR temperature and correlates it with small and large surgeries and, finally, investigates (24) the necessary strategies to provide the ideal surgical environment for maintaining normothermia in NBs. It is stipulated as thermal parameters of a neonatal operating room: room temperature with a variation of 22.7ºC to 28ºC (11,15,(24)(25)(26)(31)(32) , air humidity control between 32% and 62% (24)(25)(26)32) and quality of air cleaning, based on the International Standardization Organization (ISO) 14644-1 with numerical classes (26) .…”

“…In Chinese hospitals, other strategies have been shown to be effective, namely: heated and humidified CO 2 insufflation (35°C temperature and 95% relative humidity) in laparoscopic surgeries (32) ; rewarming of children with postoperative hypothermia with the combination of an electric blanket and a forced air heating system (34) . These resources were associated with positive postoperative results, including less tremors and hypothermia, faster recovery of bowel movements and shorter hospital stay (32) .…”

A phase I, nonrandomized controlled trial demonstrating the novel technique of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy utilizing warm humidified carbon dioxide insufflation

“…Maintaining the peritoneal cavity milieu at physiological conditions may minimize unwarranted peritoneal tissue injury thereby reducing postoperative complications. Warm humidified CO 2 (WHCO 2 ) insufflation in laparoscopic procedures has shown promise, albeit in small uncontrolled studies, in maintaining normothermia, reducing postoperative pain, time to first bowel motion and length of stay [7,9,10]. However, study results are varied, making it difficult to draw definitive conclusions.…”