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Joseph P. McDermott, MD; Mark C. Regan, MD, FRCSI; Rory Page, MB, FFARCSI; Maurice A. Stokes, MCh, FRCSI; Kevin Barry, MD, FRCSI; Denis C. Moriarty, FFARCSI, FRCA; Philip F. Caushaj, MD, FACS, FACG; John M. Fitzpatrick, MCh, FRCSI; Thomas F. Gorey, MCh, FRCSI

Arch Surg. 1995;130(9):984-988.

Abstract
Background
Patients who are undergoing laparoscopic procedures can present with a number of ventilatory and circulatory problems. The use of a gasless technique for performing a laparoscopy by using a mechanical lifting device may potentially avoid such problems.

Objective
To compare the cardiorespiratory effects of laparoscopy with and without gas insufflation.

Methods
Twelve adult pigs were randomized to undergo a laparoscopy by using either carbon dioxide insufflation or mechanical elevation. Full invasive monitoring was performed preoperatively and at 10-minute intervals throughout the operative period. Parameters that were measured included blood gas determinations, mean arterial pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output, stroke volume, and total peripheral resistance.

Results
Carbon dioxide insufflation unlike mechanical elevation led to a fall in Po₂ and absorption of a significant quantity of CO₂, resulting in hypercapnia, acidosis, and a consequent hyperdynamic circulation.

Conclusion
These findings have significant implications for the use of CO₂ insufflation for laparoscopy in patients with a compromised respiratory or cardiac status.

(Arch Surg. 1995;130:984-988)

Author Affiliations
From The Medical Center of Central Massachusetts, Worcester (Drs McDermott and Caushaj), and the Departments of Surgery (Drs Regan, Stokes, Barry, Fitzpatrick, and Gorey) and Anaesthesia (Drs Page and Moriarty), Mater Misericordiae Hospital, University College Dublin (Ireland).

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