Carboxyhemoglobinemia due to peritoneal smoke absorption from laser tissuecombustion at laparoscopy

Objective: The carbon monoxide (CO) smoke component from tissue pyrolysis w as evaluated for peritoneal ab sorption in patients undergoing laparoscopy to determine its effects and ability to be detected in peripheral blood. Su mmary Background Data: Previous studies have demonstrated changes in periph eral methemoglobin levels as a result of peritoneal absorption of laser smo ke. Methods: Fifty patients had preoperative, intraoperative, and postopera tive levels of carboxyhemoglobin (COHb) and pulse oximetry evaluated, The c ontrol group (25) had no laser or cautery used and the study group (25) had carbon dioxide laser used during the laparoscopic procedures. Results: The control group showed no change in COHb, or inh a-abdominal CO levels, befo re, during, and after the procedures, and no change in blood CO or pulse ox imetry reading. The laser smoke group showed a statistically significantly elevated (p < .05) peripheral blood COHb levels, a significant increase in intra-abdominal CO concentration, and a lack of correlation of pulse oximet ry and blood oxygen saturation experiments. Conclusions: CO is created in e xtremely large quantities during laser use at laparoscopy and is absorbed t hrough the peritoneal cavity, Symptoms of smoke poisoning can be seen with these elevations. Continuous or intermittent removal of smoke produced from laser use is recommended.