PROSPECTIVE COMPARISON OF HELIUM VERSUS CARBON-DIOXIDE PNEUMOPERITONEUM

Background: During prolonged laparoscopic operations with carbon dioxi de (CO2) pneumoperitoneum (PP), hypercapnia with significant acidosis has been reported to occur in some patients with pulmonary dysfunction . An alternate inert insufflation gas like helium (He) could avoid thi s problem. Methods: This prospective, IRB-approved study compared the cardiopulmonary response in 20 patients with both CO2 and He PP. With the minute ventilation held constant, baseline arterial blood gases an d ventilatory and cardiac parameters were obtained after anesthetic in duction but prior to CO2 PP. All values were repeated at 20 to 30 and 40 to 60-minute intervals after the insufflation of CO2 PP, then again during He PP. Values were compared by a paired t test analysis. Resul ts: Patients experienced significant hypercapnia during CO2 PP when co mpared with baseline arterial blood gases, but all values returned to baseline levels during He PP. Conclusions: He PP is an effective alter native to CO2 PP for a laparoscopic cholecystectomy avoiding CO2 reten tion and subsequent acidosis. Carbon dioxide retention may be dangerou s in patients with pulmonary dysfunction who undergo laparoscopy.