E. Esper et al., TRANSPERITONEAL ABSORPTION OF THERMOCAUTERY-INDUCED CARBON-MONOXIDE FORMATION DURING LAPAROSCOPIC CHOLECYSTECTOMY, Surgical laparoscopy & endoscopy, 4(5), 1994, pp. 333-335
Carbon dioxide pneumoperitoneum (PP) during laparoscopic cholecystecto
my (LC) causes hypercapnia and acidemia. Thermocautery carbon monoxide
formation during LC was studied in 15 patients. CO samples were read
by electrochemical sensor as parts per million (ppm) and obtained intr
aperitoneally at PP, gallbladder takedown (GBTD), and exhalation. In b
lood, CO was measured by spectrophotometry as percentage of carboxyhem
oglobin (HbCO) during anesthesia induction, at end of PP, at GBTD, and
in the recovery room. Heart rate, mean arterial pressure, oxygen satu
ration, and end-tidal CO2 were followed prospectively. Data were analy
zed by analysis of variance and Student's t test. In 35 min, thermocau
tery increased intraperitoneal CO from 4.7 +/- 3.8 ppm at baseline to
326 +/- 360 ppm at GBTD (p < 0.004). HbCO increased from PP to GBTD (0
.7 +/- 0.6 vs. 1.2 +/- 0.7%; p < 0.01). Thermocautery produces high le
vels of CO intraperitoneally, which are absorbed into the circulation.
Exposure time is short, which may explain the lack of hemodynamic and
oxygenation changes. .