INTRODUCTION: Numerous physiological responses as a result of carbon dioxide (CO2) insufflation occur in almost every organ system. The present study investigated the impact of intraperitoneal or extraperitoneal CO2 insufflation on cardiopulmonary and immunological variables during urological laparoscopic surgery.
METHODS: From August 2007 to April 2009, we performed 40 laparoscopic urological surgeries (36 transperitoneal; 4 retroperitoneal) on otherwise healthy patients. There were 16 males and 24 females. Their mean age was 39 years. All patients underwent peripheral venous blood sampling preoperatively and 24 hours postoperatively. These were analyzed for C-reactive protein (CRP), white blood cell count, and differential leukocyte count. Arterial blood gas was sampled preoperatively and intraoperatively. Measurements were started when the patient was placed in the lateral decubitus position and continued at 2-minute regular intervals until the time of emergence. End-tidal CO2 (ETCO2) was measured every 15 minutes during the entire procedure. Outcome measures were surgery duration and mean pH level, partial pressure of oxygen (pO2), ETCO2, peak airway pressure (PAP), respiratory rate (RR), oxygen (O2) saturation, mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), C-reactive protein (CRP), and leukocyte levels. Measures before and after CO2 insufflation were compared with paired t tests.
RESULTS: Mean operative time was 3.6 hours. The mean (SD) preoperative pO2 was 140.28 (25.61) mmHg, which was significantly higher than the mean intraoperative pO2 of 133.9 (24.43) mmHg (P < .05). There was no significant difference in the mean ETCO2 before and after insufflation. However, the mean change in ETCO2 at 15-minute intervals was significantly higher than the ETCO2 before insufflation. There were no significant changes in mean pH, O2 saturation, MAP, RR, ETCO2, PAP, HR, SBP, DBP, or RR. Inflammatory markers CRP and white blood cell count were statistically similar.
CONCLUSIONS: Physiological changes incurred as a result of CO2 insufflation have minimal adverse effects in healthy individuals undergoing urological laparoscopic surgery.
Mukesh Kumar Vijay, Preeti Vijay, Punit Tiwari, Suresh Kumar, Pramod Kumar Sharma, Amit Goel, Pratim Sengupta, Malay Kumar Bera
Department of Urology, Institute of Post Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
Submitted November 29, 2010 - Accepted for Publication December 19, 2010
KEYWORDS: Intra-abdominal pressure; Mean arterial pressure; Heart rate; pO2; End-tidal CO2.
CORRESPONDENCE: Mukesh Kumar Vijay, Department of Urology, Institute of Post Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, 682 A Newalipore O Block, Kolkata, West Bengal 700020, India (
CITATION: UroToday Int J. 2011 Feb;4(1):art18. doi:10.3834/uij.1944-5784.2011.02.18
ABBREVIATIONS AND ACRONYMS: CO2, carbon dioxide; CRP, C-reactive protein; DBP, diastolic blood pressure; ETCO2, end-tidal CO2; HR, heart rate; IAP, intraabdominal pressure; IL-6, interleukin-6; MAP, mean arterial pressure; O2, oxygen; PAP, peak airway pressure; pCO2, partial pressure of carbon dioxide; pO2, partial pressure of oxygen; RR, respiratory rate; SBP, systolic blood pressure.