Difficult colonoscopy: air, carbon dioxide, or water insufflation?

BACKGROUND/AIMS: This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). METHODS: Patients with body mass index (BMI) less than 18 kg/m2 or more than 30 kg/m2, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. RESULTS: The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P 30 kg/m2.

Carbon Dioxide versus Air Insufflation in Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO2) use has been shown to cause less post-procedural pain and fewer adverse events. The objective of this study was to compare the post-procedural pain and adverse events associated with CO₂ and air insufflation in ESD. METHODS: A systematic search was conducted for randomized control trials (RCTs) comparing the two approaches in ESD. The Mantel-Haenszel method was used to analyze the data. The mean difference (MD) and odds ratio (OR) were used for continuous and categorical variables, respectively. RESULTS: Four RCTs with a total of 391 patients who underwent ESD were included in our meta-analysis. The difference in maximal post-procedural pain between the two groups was statistically significant (MD, -7.41; 95% confidence interval [CI], -13.6 – -1.21; p=0.020). However, no significant differences were found in the length of procedure, end-tidal CO2, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO2 group (OR, 0.51; CI, 0.32–0.84; p=0.007). CONCLUSIONS:: CO2 insufflation in gastric ESD is associated with less post-operative pain and discomfort, and a lower risk of overall adverse events compared with air insufflation.

Effects of carbon dioxide insufflation on regional cerebral oxygenation during laparoscopic surgery in children: a prospective study / Efeitos da insuflação de dióxido de carbono sobre a oxigenação cerebral regional durante cirurgia laparoscópica em crianças: um estudo prospectivo

ABSTRACT BACKGROUND AND OBJECTIVES: Laparoscopic surgery has become a popular surgical tool when compared to traditional open surgery. There are limited data on pediatric patients regarding whether pneumoperitoneum affects cerebral oxygenation although end-tidal CO2 concentration remains normal. Therefore, this study was designed to evaluate the changes of cerebral oxygen saturation using near-infrared spectroscope during laparoscopic surgery in children. METHODS: The study comprised forty children who were scheduled for laparoscopic (Group L, n = 20) or open (Group O, n = 20) appendectomy. Hemodynamic variables, right and left regional cerebral oxygen saturation (RrSO2 and LrSO2), fraction of inspired oxygen, end-tidal carbon dioxide pressure (PETCO2), peak inspiratory pressure (Ppeak), respiratory minute volume, inspiratory and end-tidal concentrations of sevoflurane and body temperature were recorded. All parameters were recorded after anesthesia induction and before start of surgery (T0, baseline), 15 min after start of surgery (T1), 30 min after start of surgery (T2), 45 min after start of surgery (T3), 60 min after start of surgery (T4) and end of the surgery (T5). RESULTS: There were progressive decreases in both RrSO2 and LrSO2 levels in both groups, which were not statistically significant at T1, T2, T3, T4. The RrSO2 levels of Group L at T5 were significantly lower than that of Group O. One patient in Group L had an rSO2 value <80% of the baseline value. CONCLUSIONS: Carbon dioxide insufflation during pneumoperitoneum in pediatric patients may not affect cerebral oxygenation under laparoscopic surgery.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cirurgia laparoscópica se tornou uma ferramenta cirúrgica popular em comparação com a cirurgia aberta tradicional. Há poucos dados sobre pacientes pediátricos no que se refere ao pneumoperitônio afetar a oxigenação cerebral enquanto a concentração de CO2 no fim da expiração continua normal. Portanto, este estudo teve como objetivo avaliar as alterações da saturação de oxigênio cerebral com espectroscopia de infravermelho próximo durante cirurgia laparoscópica em crianças. MÉTODOS: O estudo recrutou 40 crianças programadas para apendicectomia laparoscópica (Grupo L, n = 20) ou aberta (Grupo A, n = 20). Variáveis hemodinâmicas, saturação de oxigênio cerebral regional direita e esquerda (RrSO2 e LrSO2), fração inspirada de oxigênio, pressão expiratória final de dióxido de carbono (PETCO2), pico de pressão inspiratória (Ppico), volume minuto respiratório, concentrações de sevoflurano inspirado e expirado e temperatura corporal foram registrados. Todos os parâmetros foram registrados após a indução da anestesia e antes do início da cirurgia (T0, basal), 15 minutos após o início da cirurgia (T1), 30 minutos após o início da cirurgia (T2), 45 minutos após o início da cirurgia (T3), 60 minutos após o início da cirurgia (T4) e no fim da cirurgia (T5). RESULTADOS: Houve diminuição progressiva em ambos os níveis de RrSO2 e LrSO2 nos dois grupos, mas não foi estatisticamente significativa em T1, T2, T3, T4. Os níveis de RrSO2 do Grupo L em T5 foram significativamente menores do que os do Grupo A. Um paciente do Grupo L apresentou um valor rSO2 < 80% do valor basal. CONCLUSÕES: A insuflação de dióxido de carbono durante o pneumoperitônio em pacientes pediátricos pode não afetar a oxigenação cerebral em cirurgia laparoscópica.

Clinical differences between artificial pneumothorax and double lumen intubation in thoracoscopic esophagectomy / 局解手术学杂志

Objective To explore the advantages and disadvantages of the double lumen endotracheal intubation and single -lumen endo-tracheal intubation and continuous carbon dioxide insufflation in thoracoscopic esophagectomy .Methods The clinical data of 90 patients in our department of thoracic surgery after thoracoscopic esophagectomy from January 2014 to April 2015 were analyzed .All patients were divid-ed into single-lumen endotracheal intubation (group A)and double lumen endotracheal intubation group (group B).The endotracheal intuba-tion time,operation time,incidence of pulmonary infection,intraoperative and postoperative PaO2,PaCO2,incidence of anastomotic fistula, hospitalization expenses ,length of hospital stay and the incidence of postoperative chylothorax between two groups were compared .Results The difference in intraoperative PaO2,PaCO2,incidence of pulmonary infection,endotracheal intubation time,operation time,hospitalization days and the hospitalization cost between two groups were statistical significance .The difference of the rest index between two groups were no statistical significance.Conclusion Group A has certain advantages in perioperative management ,hospitalization cost and so on,but has disadvantages in perioperative hypoxemia and carbon dioxide retention and acid -base balance disorders .

Severe Hypercapnia during Cardiopulmonary Bypass due to Carbon Dioxide Insufflation: A case report / 대한마취과학회지

Air embolization is a potential danger during open heart surgery. To prevent air embolization in incompletely deaired cardiac chambers, flooding of the surgical fields with carbon dioxide (CO2) is used during cardiopulmonary bypass. CO2 flooding may be more useful in de-airing for patients undergoing minimally invasive cardiac surgery. We experienced an episode of sudden, severe hypercapnia and respiratory acidosis in a 51-year-old female patient during hypothermic cardiopulmonary bypass for minimally invasive mitral valve replacement. During hypercapnia, hemodynamic and BIS data were stable except for a slight increase in mean arterial pressure. After ruling out other causes of hypercapnia such as oxygenator failure and malignant hyperthermia, severe hypercapnia disappeared gradually after the cessation of CO2 flooding in the surgical field. No neurologic or cardiopulmonary complications were noted after the operation. We concluded that frequent or continuous CO2 monitoring may be required during CO2 insufflation at surgical fields to prevent hypercapnic complications in minimally invasive cardiac surgery.

The carbon dioxide insufflation volume required to attain adequate pneumoperitoneum in gynecologic laparoscopy patients

Objectives: The objectives of this study were to determine the carbon dioxide insufflation volume needed to attain pneumoperitoneum in patients who underwent gynecologic laparoscopic surgery and to determine if body mass index (BMI) and parity affected the carbon dioxide insufflation volume. Methodology: The insufflation volume of carbon dioxide was noted after a present pressure of 16 mm Hg was attained in the carbon dioxide insufflator for patients who underwent laparoscopy. Patients were grouped according to BMI and parity. The mean, standard deviation and range was computed for the carbon dioxide insufflation volume. One-way analysis of variance was used to determine the significance of BMI and parity in relation to carbon dioxide insufflation volume. Results: The mean carbon dioxide insufflation volume needed to for pneumoperitoneum was 3.15 liters. When grouped according to BMI and parity, there were significant differences in carbon dioxide insufflation volume.

Comparison of Open and Laparoscopic Cholecystectomies / 대한마취과학회지

Laparoscopic cholecystectomy, a surgical technique first performed in France, which has gained widespread acceptance among surgeons in Korea. The advantages of the laparoscopic technique include lesser patient discomfort, shorter hospitalization, and a shorter return interval to full activities after operation. It has been postulated that due to the minimal incisional discomfort of laparoscopic cholecystectomy, the postoperative pulmonary function following this procedure would be improved as compared to open cholecystectomy. Laparoscopic cholecystectomy uses carbon dioxide, a highly diffusable gas, for insufflation. With extended periods of insufflation, a patient's arterial carbon dioxide levels may be adversely altered. We performed 44 laparoscopic cholecystectomy in 1993. There were 22 women and 22 men, with a mean age of 50.0+/-11.9 years. The mean operative time was 86.7+/-24.3 minutes, reflecting a 62 percent decrease in operative time compared to the open cholecystectomy. The mean hospital stay was 4.6+/-2.0 days. To analyze the hemodynamic effects of carbon dioxide during laparoscopic cholecystectomy, the changes of pH, PaCO2, PaO2, and SaO2 were studied. The measurement showed significant increase of arterial carbon dioxide. Finally, during laparoscopic cholecystectomy patients may require careful intraopererative arterial blood gas monitoring of the absorbed carbon dioxide.

Cardiovascular and Ventilatory Changes during Laparoscopic Cholecystectomy under General Anesthesia / 대한마취과학회지

Peritonesl insufflation of CO2 to creste the pneumoperitoneum necessary far laparoscopy in- duces intraoperative cardiovascular and ventilatory changes that complicste anesthetic management of laparoscopy. We investigated cardiovascular and ventilstory changes during laparoscopic cholecystectomy under general anesthesia in 11 healthy patients. During operation, intraabdominal pressure was maintained automatically at 14 mmHg by a CO2 insufflator and controlled ventilation setting was adjusted at the values of PaCO2 about 30 mmHg before peritoneal insufflation, and this ventilatory setting was not changed throughout the operation. We measured peak inspiratory pressure(Ppi), mean arterial pressure(MAP), pulse rate(PR), arterial blood gas and end tidal carbon dioxide(PEtCO2) before and during peritoneal insufflation, snd after peritoneal exsufflation. Peritoneal insufflation of CO2 resulted in a significant increase of Ppi, MAP, PaCO2 and PEtCO2, a significant decrease of pH. And PaCO2 and pH were not restored until 15 minutes after CO2 exsufflation. PR and PaO2 were not changed significantly throughout the operation. Conclusively, during general anesthesia for laparoscopic choleeystectomy, hyperventilation was needed under the monitoring of PEtCO2 or PEt,CO2 and special care and monitoring was mendatory for the patients with impaired cardiopulmonary function and increased intracranial pressure.

Changes in Pulmanary Gas Exchange during General Anesthesia for Laparoscopic Cholecystectomy / 대한마취과학회지

The recent development of laparoscopic cholecysteetomy has introduced the technique of laparoscopy to the general surgical operation. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation in order to visualize better the abdominal viscera may causes some problems-hypercarbia, hypertension, pneumomediastinum, subcutaneous emphysema and cardiovascular impairment, We studied the changes of cardiovascular system and pulmonary gas exchanges clinically during general anesthesia for laparoscopic eholecystectomy in the 16 patients of Seoul National University Hospital. After induction of anesthsia, ventilation was controlled with tidal volume 10 ml/kg and respiration rate 10-15/min to maintain PaCO2 35 mmHg before insufflation of carbon dioxide. After measuring of control value of mean arterial pressure(MAP), heart rate(HR) and arterial blood gas analysis before insufflation of CO2, ventilation setting was not changed throughout the operation. MAP, HR, arterial blood gas analysis were measured at 30 min interval until the end of operation. The changes of MAP, HR and PaO2, throughout the operation are not statistically significant in comparison to control(preinsufflation) values. The PaCO2 was increased significantly by 8-10 mmHg in comparison to control values(p-value<0.01). In conclusion, minute ventilation should be corrected during general anesthesia for laparoscapic cholecysteetomy with CO2 insufflation according to continuous monitoring of end tidal CO2 and arterial carbon dioxide tension.

Nicardipine and labetalol in controlling hypertension during laparoscopic cholecystectomy / 第二军医大学学报

Objective: To compare the effects of nicardipine and labetalol on hypertension during laparoscopic cholecystectomy.Methods:Thirty patients with hypertension undergoing selective laparoscopic cholecystectomy were randomly divided into 3 groups. The control group was only given anesthetic drugs; nicardipine group was given nicardipine 20 ?g?kg -1 ?min -1 before induction, followed by intravenous continuous infusion of nicardipine at the rate of 0.5 1.5 ?g?kg -1 ?min -1 ; labetalol group received labetalol 0.3 mg?kg -1 ?min -1 before induction followed by intravenous continuous infusion of labetalol at the rate of 10 20 ?g?kg -1 ?min -1 . Results: Statistical differences( P