Metabolic Effects of Carbon Dioxide Insufflation During Laparoscopic Surgery: Changes in pH, Arterial Partial Pressure of Carbon Dioxide (PaCO2) And End Tidal Carbon Dioxide (ETCO2)

ABSTRACT

Background: Laparoscopy involves inspecting the abdomen and pelvis using an endoscope. Carbon dioxide (CO2) is the gas that is commonly used to insufflate the abdomen so as to facilitate the surgical view. Aim: The present study was under taken to determine the Metabolic effects of carbon dioxide insufflation during laparoscopic surgery. Methods: An observational study on 50 patients above 18 years of age with physical status of American Society of Anaesthesiologists (ASA) Class I and II after obtaining approval from institutional ethical committee and consent of the patient was conducted in the Postgraduate Department of Anaesthesiology and Critical Care, Government Medical College Srinagar. Results: There was a progressive decrease in the pH during pneumoperitoneum in keeping with the hypercarbia. An increase towards baseline was observed during recovery but pH was still significantly lower than baseline 15 minutes into recovery (p<0.118). The Pco2 increased after 15 mins Co2 insufflation & peaked at 30 mins with mean & SD 42.82,2.775 & 46.16,2.909 respectively which was statically significant. Etco2 also increased after 15 mins of Co2 insufflation & peaked at 30 mins with mean 41.56 & 44.50 respectively which was statically significant. Similarly, Hco3 decreased over period of time with peak decrease at 30 mins of Co2 insufflation with mean 23.70, SD 1.919 & range 19-27. Conclusion: Co2 insufflation does bring metabolic changes in Ph, Pco2, Etco2 & HCO3 but with proper monitoring & management laparoscopic procedure can be safely performed.