The effect of heating insufflation gas on acid-base alterations and core temperature during laparoscopic major abdominal surgery

Abstract

BackgroundCarbon dioxide (CO2) has different biophysical properties under different thermal conditions, which may affect its rate of absorption in the blood and the related adverse events. The present study was aimed to investigate the effects of heating of CO2 on acid-base balance using Stewart's physiochemical approach, and body temperature during laparoscopy.MethodsThirty adult patients undergoing laparoscopic major abdominal surgery were randomized to receive either room temperature CO2 (control group, n = 15) or heated CO2 (heated group, n = 15). The acid-base parameters were measured 10 min after the induction of anesthesia (T1), 40 min after pneumoperitoneum (T2), at the end of surgery (T3) and 1 h after surgery (T4). Body temperature was measured at 15-min intervals until the end of the surgery.ResultsThere were no significant differences in pH, PaCO2, the apparent strong ion difference, the strong ion gap, bicarbonate ion, or lactate between two groups throughout the whole investigation period. At T2, pH was decreased whereas PaCO2 was increased in both groups compared with T1 but these changes were not significantly different. Body temperatures in the heated group were significantly higher than those in the control group from 30 to 90 min after pneumoperitoneum.ConclusionsThe heating of insufflating CO2 did not affect changes in the acid-base status and PaCO2 in patients undergoing laparoscopic abdominal surgery when the ventilator was set to maintain constant end-tidal CO2. However, the heated CO2 reduced the decrease in the core body temperature 30 min after the pneumoperitoneum.

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“…As for blood gases, it has been suggested that the heating of CO 2 could increase its absorption rate in the blood stream and so the risk of hypercapnia and acidosis. 13,14 More recently, Lee et al 28 conducted a randomized clinical study on 30 human patients, concluding that the heating of the insufflated CO 2 did not induce any significant changes in the acid-base status and PaCO 2 in patients undergoing laparoscopic abdominal surgery when the ventilator was set to maintain constant end-tidal CO 2 . Our results are in line with the conclusions of Lee et al, confirming that no significant blood gas changes are induced by the heated CO 2 during surgery.…”