Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

Abstract

Background:Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery.Methods:One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded.Results:Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05).Conclusion:Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.

The “Dark Side” of Pneumoperitoneum and Laparoscopy

“…In a randomized and controlled trial of 44 women undergoing deep endometriosis surgery, a decreased degree of adherence formation was found by inducing the pneumoperitoneum with a cooled and humidified gas composed of a mixture of 86% CO 2 , 10% N 2 O, and 4% O 2 [78]. ese findings are in accordance with the clinical report of reduced pain complaint, length of stay, and analgesic use in subjects receiving heated humidified CO2 compared to those treated with dry CO2 [79].…”

Humidified Warmed CO2 Treatment Therapy Strategies Can Save Lives With Mitigation and Suppression of SARS-CoV-2 Infection: An Evidence Review

“…Additionally, warmed and humidified CO 2 insufflation leads to an improved body core temperature (BCT) maintenance, a reduction of the inflammatory and cytokine responses (58,59) and improved quality of postoperative course, compared with standard insufflation (60,61). Also, it can reduce intraoperative hypothermia, coagulation dysfunction, early postoperative cough pain, days to first flatus and solid food intake, and the length of hospital stays (62). In recent years, CO 2 -based technologies have accordingly gained considerable interest in the pharmaceutical industry.…”

Influence of insufflated carbon dioxide on abdominal temperature compared to oesophageal temperature during laparoscopic surgery

“…Normally it is used not humidified and at room temperature (20–22 °C). Some groups evaluated the effects of insufflated CO 2 on intraoperative body temperature as well as on postoperative pain and length of hospital stay [ 15 , 21 ]. The two meta-analyses of Dean et al and Balayssac et al were able to show positive effects of warmed, humidified CO 2 compared to controls without warming [ 16 , 21 ].…”

“…The two meta-analyses of Dean et al and Balayssac et al were able to show positive effects of warmed, humidified CO 2 compared to controls without warming [ 16 , 21 ]. Jiang et al, however, demonstrated that warmed, humidified CO 2 or combined forced air warming with CO 2 at room temperature are equivalent [ 15 ].…”

“…Surgery-related risks include the surgical technique, the duration of surgery, the extent of the procedure, and the amount of irrigation fluid used [13]. Some studies showed that laparoscopic surgery can negatively influence body temperature by using carbon dioxide (CO 2 ) at room temperature [14][15][16]. Nevertheless, laparoscopic surgery mostly is performed without pre-warming and humidifying CO 2 .…”