Helium insufflation for laparoscopic operation

Abstract

Laparoscopic surgical procedures are becoming simultaneously more commonplace and complex. However, carbon dioxide (CO2) pneumoperitoneum required for these procedures causes a respiratory acidosis. We undertook this study to determine if an alternate insufflating gas, such as helium, prevents this sequelae. Twenty patients undergoing elective laparoscopic cholecystectomy were randomized to receive either CO2 or helium insufflation. Intraoperative parameters, including arterial CO2 (PaCO2), end-tidal CO2, pH, bicarbonate (HCO3-), cardiac output and blood pressure were obtained before, during and at the conclusion of pneumoperitoneum. Effects of the two gases on these variables were compared. The average CO2 rose significantly from 35.7 +/- 1.0 to 50.4 +/- 3.2 (p < 0.0001), while pH decreased from 7.434 +/- 0.014 to 7.286 +/- 0.018 (p < 0.0001) in those who received CO2. No change in PaCO2 was observed in those who received He, although a small decrease in pH from 7.428 +/- 0.011 to 7.392 +/- 0.012 (p < 0.05) was observed. HCO3- decreased slightly in both groups. Increases in blood pressure and pulse rate were independent of the gas received. The cardiac output did not change. Helium insufflation for laparoscopic cholecystectomy does not produce the respiratory acidosis caused by CO2 and, therefore, merits further investigation for use, particularly in patients with underlying respiratory disease.