Comparison of immunologic and physiologic effects of CO2 pneumoperitoneum at room and body temperatures

Background: Prolonged and complex laparoscopic procedures expose patients t o large volumes of cool insufflation gas. The aim of this study was to comp are the effects of a conventional room temperature carbon dioxide (CO2) pne umoperitoneum with those of a body temperature pneumoperitoneum. Methods: Patients were randomized to undergo laparoscopic cholecystectomy w ith a CO2 pneumoperitoneum warmed to either body temperature (n = 15) or ro om temperature (n = 15). The physiologic and immunologic effects of warming the gas were examined by measuring peroperative core and intraperitoneal t emperatures, peritoneal fluid cytokine concentrations, and postoperative pa in. Results: The mean duration of surgery was 32 min in both groups. Core tempe rature was reduced in the room temperature group (mean, 0.42 degrees C; p < 0.05). No reduction in temperature occurred when the gas was warmed. Great er levels of cytokines were detected in peritoneal fluid from the room temp erature insufflation group tumor necrosis factor alpha (TNF-alpha): mean, 1 0.9 pg/ml vs. 0.42, p < 0.05; interleukin 1 beta (IL-1 beta): mean, 44.8 pg /ml vs. 15.5, p < 0.05; and IL-6: mean, 60.4 ng/ml vs. 47.2. Then was no di fference in postoperative pain scores or analgesia consumption between the two groups. Conclusions: The authors conclude that intraoperative cooling can be preven ted by warming the insufflation gas, even in short laparoscopic procedures. In addition, warming the insufflation gas leads to a reduced postoperative intraperitoneal cytokine response.