Comparison of immunologic and physiologic effects of CO2 pneumoperitoneum at room and body temperatures

Abstract

The authors conclude that intraoperative cooling can be prevented by warming the insufflation gas, even in short laparoscopic procedures. In addition, warming the insufflation gas leads to a reduced postoperative intraperitoneal cytokine response.

Laparoscopic surgery in children is associated with an intraoperative hypermetabolic response

“…However, the decrease in temperature was not statistically significant. Other investigators have found that the use of unheated CO 2 for peritoneal insufflation can be associated with a decrease in body temperature and that the use of warm CO 2 prevented hypothermia and blunted the cytokine response [18]. Another study in adults showed that nasopharyngeal temperature increased after 1 h of pneumoperitoneum with heated CO 2 [20].…”

Abdominal Effects Of Laparoscopic Surgery

“…[25] The passage of CO2 through the insufflator and tubing apparatus raises this temperature to approximately room temperature (19°C-21°C) at the point of delivery to the peritoneal cavity with a relative humidity approaching 0% at the point of entry into the peritoneal cavity. [34][35][36] However, this still is significantly lower than the normal intraperitoneal or core temperature. Large volumes of gas may be required for a single patient (up to 500 litres), owing to the imperfect seal of the laparoscopic ports and peritoneal CO2 absorption.…”

“…Prolonged insufflation with CO2 is associated with a reduction in body temperature as well as the intraperitoneal humidity. [25,34,37] The disadvantages of peri-operative hypothermia are well known and includes increased rates of postoperative infection, increased cardiac output and prolonged postoperative recovery. [25] With respect to the desiccation and temperature factors, there are potential added benefits of using warmed and humidified CO2.…”

Chirurgische Maßnahmen zur Schmerzreduktion bei abdominalchirurgschen Eingriffen

“…Nach laparoskopischer Cholezystektomie führte die Verwendung eines Niedrigdruck-Pneumoperitoneums im Vergleich zu höherem intraabdominellen Druck zu geringeren postoperativen NRSSchmerz-Scores und einer Reduktion der Analgetikadosis [19,20]. Dagegen führte die Verwendung von angewärmtem Insufflationsgas (37 °C) im Vergleich zu ungewärmtem CO2 in 3 RCT nicht zu einer Reduktion der postoperativen NRS-Scores für Schmerzen [21][22][23]. Gaslose Verfahren zur Anhebung der Bauchdecke hatten in zwei RCT bei laparoskopischen Cholezystektomien gleichfalls nicht zu verminderten postoperativen Schmerzen geführt [24,25].…”