| [ Summary ] |
Carbon dioxide, nitrous oxide, helium and air have been used as insufflation agents for pneumoperitoneum. Air and helium are generally avoided because of their extremely low solubility in blood which may cause severe circulatory depression via gas embolism. CO2 pneumoperitoneum is associated with adverse effects, such as respiratory changes, cardiovascular changes and postoperative pain. Respiratory effects include hypercarbia, elevation of airway pressure, decreased total lung compliance, subcutaneous emphysema, pneumothorax and carbon dioxide gas embolism. Cardiovascular changes may be caused by peritoneal distension resulting in sympathetic stimulation, mechanical compression of intra-abdominal vessels and hypercarbia. Severe surgical complications during the creation of pneumoperitoneum are gas embolism, massive bleeding via perforation of large vessels and gastro-intesinal perforation. Burning of tissue by electrocautery in a hypoxic environment during pneumoperitoneum can produce carbon monoxide. However, blood levels of carboxyhemoglobin do not rise in the clinical setting. Understanding the physiologic changes produced by pneumoperitoneum, in conjunction with intensive monitoring, can assure safe management of patients during laparoscopic procedures. |