Double-blind, Prospective, Randomized Study of Warmed, Humidified Carbon Dioxide Insufflation vs Standard Carbon Dioxide for Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Patients undergoing warmed, humidified carbon dioxide (CO 2) insufflation for laparoscopic cholecystectomy will (1) maintain a warmer intraoperative core temperature, (2) have their surgeon experience less fogging of the camera lens, and (3) have less postoperative pain than patients undergoing laparoscopic cholecystectomy with standard CO 2 insufflation. Design: A double-blind, prospective, randomized study comparing patients undergoing laparoscopic cholecystectomy with standard CO 2 insufflation vs those receiving warmed, humidified CO 2 (Insuflow Filter Heater Hydrator; Lexion Medical, St Paul, Minn) was performed. Main variables included patient core temperature, postoperative pain, analgesic requirements, and camera lens fogging. Results: One hundred one blinded patients (69 women, 32 men) undergoing laparoscopic cholecystectomy were randomized into 2 groups-52 receiving standard CO 2 insufflation (group A) and 49 receiving warmed, humidified CO 2 (group B). Mean patient intraoperative core temperature change (group A decreased by 0.03°C, group B increased by 0.29°C, P=.01) and mean abdominal pain (Likert scale, 0-10) at 14 days postoperatively (group A, 1.0; group B, 0.3; P =.02) were different. Other variables (camera lens fogging, early postoperative pain, narcotic requirements, recovery room stay, and return to normal activities) between groups were similar. Conclusion: While patients undergoing laparoscopic cholecystectomy with warmed, humidified CO 2 had several advantages that were statistically significant, no major clinically relevant differences between groups A and B were evident.

Abdominal Adhesion Prevention: Still a Sticky Subject

“…This is due to a combination of ischemia, acidosis and desiccation. Amelioration of peritoneal damage may be achieved by heating and humidifying the CO 2 as well as reducing gas flow rate and insufflation pressures [88,89,90]. Although some damage to the peritoneum is inevitable, protective measures such as these may allow quicker resolution of any insult.…”

Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

“…Reports of other gases are rare, they have no advantage over CO 2, except N 2 O is discussed to have some role in cases of pulmonary dysfunction [20] . Warmed and humidifi ed CO 2 gas offers the patient postoperative advantages like less shoulder pain and less abdominal pain [21] .…”

Beneficial Effects of Humidified, Warmed Carbon Dioxide Insufflation During Laparoscopic Bariatric Surgery: A Randomized Clinical Trial. What if Sample Size Calculation Made Difference?

“…The authors state their primary endpoints were visual analogic pain scores (VAS) and morphine requirements. They refer to an older article [2] but, unfortunately, seem to have failed sample size calculation. Nowhere in this reference article is the variability (SD) in morphine requirement at 24 h 10 mg.…”