Published in:
01-10-2011
Physiologic effects of simultaneous carbon dioxide insufflation by laparoscopy and colonoscopy: prospective evaluation
Published in: Surgical Endoscopy | Issue 10/2011
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Background
The use of intraoperative carbon dioxide (CO2) colonoscopy during a laparoscopic colon operation is becoming more common. Simultaneous intracolonic and intraabdominal CO2 insufflation may result in significant physiologic changes, but in-depth physiologic effects have not been studied to date. This study aimed to evaluate the physiologic changes and the overall safety of simultaneous CO2 laparoscopy and colonoscopy.
Methods
A prospective pilot study was performed with 26 subjects (17 men and 9 women) undergoing laparoscopic surgical treatment for colorectal conditions adjunctively managed with CO2 intraoperative colonoscopy. Surgery proceeded with CO2 insufflation to a maximum pressure of 12 mmHg by laparoscopy and with a maximum CO2 flow of 5 l/min via colonoscopy. Serial intra- and postoperative arterial blood gases, end-tidal CO2, and minute ventilation were recorded during predetermined periods: during initial laparoscopy, during simultaneous colonoscopy and laparoscopy, during laparoscopy after colonoscopy, and after desufflation.
Results
No significant morbidity resulted from simultaneous CO2 insufflation. Three patients had a CO2 partial pressure (PaCO2) greater than 50, and one patient with a body mass index (BMI) higher than 42 kg/m2 had a PaCO2 greater than 50 for more than 30 min and was compensated by increasing minute ventilation. The mean pH was 7.36 in the recovery room. Postoperatively, no patient had a pH lower than 7.3, prolonged intubation, or reintubation.
Conclusion
Simultaneous CO2 colonoscopy and laparoscopy lead only to transient alterations in respiratory parameters that can be compensated. Based on these findings, simultaneous insufflation of CO2 into the peritoneal cavity and the large bowel lumen during complex endoscopic procedures may be considered safe for most patients.