COMPARATIVE STRESS HORMONE CHANGES DURING HELIUM VERSUS CARBON-DIOXIDE LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic surgery has been termed minimally invasive surgery by adv ocates of this technology. It has been demonstrated previously that us ing carbon dioxide for insufflation produces a respiratory acidosis du e to transperitoneal absorption of gas. Insufflation with helium does not create this acidosis. We questioned whether laparoscopic surgery w ould elicit a stress response and,whether the absence of acidosis with helium might prevent or reduce the levels of stress hormones. Sixteen female patients undergoing laparoscopic cholecystectomy were randomly assigned to helium (n = 8) or CO2 (n = 8) insufflation. Serum cortiso l, epinephrine, and norepinephrine were measured preoperatively, after induction of anesthesia but before insufflation, at 45 min of surgery , and after desufflation. There were increases in epinephrine, norepin ephrine, plasma cortisol, and urine cortisol at 45 min and at the conc lusion of the procedure over the preoperative value. With ANOVA, each variable showed significant increases from preoperative values, at 45 min, and at the end of the case. Except for the increased epinephrine when helium was used, there were no significant differences in the oth er variables between helium and CO2. Laparoscopic cholecystectomy prod uces significant increases in stress hormone levels. Prevention of aci dosis with helium insufflation does not appear to protect against incr eases in stress hormones. Epinephrine levels with helium insufflation are higher than with CO2, and elevations in stress hormones suggest th at laparoscopic cholecystectomy is not physiologically minimally invas ive.