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Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication?

Published online by Cambridge University Press:  23 December 2004

M. Soro ,
M. L. García-Pérez ,
R. Ferrandis ,
G. Aguilar  and
F. J. Belda
M. Soro
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
M. L. García-Pérez
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
R. Ferrandis
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
G. Aguilar
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
F. J. Belda
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
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Abstract

Summary

Background and objective: One of the complications of laparoscopic surgery is carbon monoxide production during electrocautery. The aim of our study was to ascertain the relationship between intraperitoneal and alveolar concentrations of carbon monoxide and systemic carboxyhaemoglobin in patients undergoing laparoscopic cholecystectomy and anaesthetized with a closed system, where the carbon monoxide excreted through the lungs is accumulated in the circuit and thus re-inhaled.

Methods: Nine consecutive patients undergoing laparoscopic cholecystectomy were studied. Patients' lungs were ventilated with a closed anaesthesia breathing system (Physioflex®). Measurements were taken after establishing pneumoperitoneum (baseline) and at 5, 15 and 30 min after starting electrocautery.

Results: Mean duration of pneumoperitoneum was 42 ± 13 min with cumulative electrocautery time of 2.4 ± 1.8 min. Intraperitoneal carbon monoxide concentrations increased significantly at 5, 15 and 30 min reaching peak values of 481 ± 151 ppm at 15 min. No significant differences were found in alveolar carbon monoxide and carboxyhaemoglobin concentrations with respect to baseline.

Conclusions: No significant increase in carboxyhaemoglobin is produced during laparoscopic surgery, even under closed-system anaesthesia without pulmonary carbon monoxide elimination. This is most likely due to a low peritoneal absorption of carbon monoxide. We conclude that in adult patients, no carbon monoxide intoxication is caused if reasonable periods of electrocautery are used and the intraperitoneal gas is regularly renewed.

Keywords

ANAESTHESIA, closed-systemCARBON MONOXIDELAPAROSCOPYGENERAL ANAESTHESIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 483 - 488
Copyright
2004 European Society of Anaesthesiology

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