R Y Fleming1, T B Dougherty, B W Feig. 1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Abstract
BACKGROUND: A search for alternative methods of abdominal insufflation has been prompted by the fact that CO2 insufflation may cause acidosis, decreased cardiac output, increased systemic vascular resistance, and increased cardiac filling pressures. This study evaluates the safety and the cardiopulmonary effects of helium abdominal insufflation (HAI). METHODS: Thirteen ASA class III and IV patients undergoing laparoscopic procedures were studied in a prospective, nonrandomized protocol using HAI. Cardiopulmonary parameters were measured before and after anesthetic induction and every 30 min during HAI. Abdominal insufflation pressure was initially 10 mmHg and was increased to 15 mmHg after 30 min. All measurements were repeated 15 min after deflation of the abdomen. Changes were evaluated by ANOVA. RESULTS: No significant cardiopulmonary complications were observed. No patient developed hypercarbia or acidosis. Peak inspiratory pressure increased with HAI from 20 +/- 1 to 34 +/- 2 cm H2O (p < 0.0001). Cardiac index decreased (3.35 +/- 0.19 vs 2.37 +/- 0.19 l/min/m2; p = 0.0303) and systemic vascular resistance increased (1,123 +/- 66 vs 1,406 +/- 126 dyne . s/cm5; p = 0.0512) while cardiac filling pressures increased with insufflation to 15 mmHg. CONCLUSIONS: Minimal cardiac and pulmonary aberrations were observed. Helium was safe for abdominal insufflation and may be the insufflating agent of choice in patients with significant cardiopulmonary disease.
BACKGROUND: A search for alternative methods of abdominal insufflation has been prompted by the fact that CO2 insufflation may cause acidosis, decreased cardiac output, increased systemic vascular resistance, and increased cardiac filling pressures. This study evaluates the safety and the cardiopulmonary effects of heliumabdominal insufflation (HAI). METHODS: Thirteen ASA class III and IV patients undergoing laparoscopic procedures were studied in a prospective, nonrandomized protocol using HAI. Cardiopulmonary parameters were measured before and after anesthetic induction and every 30 min during HAI. Abdominal insufflation pressure was initially 10 mmHg and was increased to 15 mmHg after 30 min. All measurements were repeated 15 min after deflation of the abdomen. Changes were evaluated by ANOVA. RESULTS: No significant cardiopulmonary complications were observed. No patient developed hypercarbia or acidosis. Peak inspiratory pressure increased with HAI from 20 +/- 1 to 34 +/- 2 cm H2O (p < 0.0001). Cardiac index decreased (3.35 +/- 0.19 vs 2.37 +/- 0.19 l/min/m2; p = 0.0303) and systemic vascular resistance increased (1,123 +/- 66 vs 1,406 +/- 126 dyne . s/cm5; p = 0.0512) while cardiac filling pressures increased with insufflation to 15 mmHg. CONCLUSIONS: Minimal cardiac and pulmonary aberrations were observed. Helium was safe for abdominal insufflation and may be the insufflating agent of choice in patients with significant cardiopulmonary disease.
Authors: C J O'Boyle; A C deBeaux; D I Watson; R Ackroyd; T Lafullarde; J Y Leong; J A R Williams; G G Jamieson Journal: Surg Endosc Date: 2002-01-09 Impact factor: 4.584