Intestinal perfusion during pneumoperitoneum with carbon dioxide, nitrogen, and nitric oxide during laparoscopic surgery

Objective: To find out what effect insufflation pressure and type of gas ha ve on intestinal perfusion during pneumoperitoneum. Design: Randomized, controlled, prospective, experimental study. Setting: University affiliated animal experimental laboratory, Sweden. Animals: Fasted, anaesthetised, domestic pigs of both sexes operated on lap aroscopically (n = 7, weight 26-31 kg). Interventions: Insufflation of carbon dioxide (CO2), nitric oxide (NO), or nitrogen (N-2) at intra-abdominal pressures of 0, 5, 10, 15 and 20 mm Hg. Main outcome measures: Cardiac output, portal blood flow, and jejunal mucos al perfusion. Results: Cardiac output decreased during N-2 and NO (15, 20 mm Hg) but not during CO2 insufflation because of an accompanying tachycardia. Portal Flow decreased during insufflation with N-2 and NO (15, 20 mm Hg) and CO2 (20 m m Hg). Jejunal perfusion was reduced during N-2 and NO insufflation (5-20 m m Hg) but remained unchanged during CO2 insufflation (5-20 mm Hg). Conclusions: Insufflation with CO2 maintained jejunal mucosal perfusion, pr obably as a result of hypercarbia as N-2 at equal pressures reduced mesente ric flow. The vasodilator NO provided no haemodynamic benefit.