Measurement of CO2 hypothermia during laparoscopy and pelviscopy: How coldit gets and how to prevent it

Study Objective. To evaluate intraabdominal CO2 temperature during a variet y of standard operative laparoscopy procedures with different insufflators (BEI Medical, Snowden & Fencer, Storz Laparoflator, Storz Endoflator, Wolf) and devices to maintain body temperature (Bair Hugger, fluid warmer, Blank etrol blankets). Design. Prospective, nonrandomized study (Canadian Task Force classificatio n II-1). Setting. Community hospital in rural Alabama. Patients. Sixty-two consecutive patients (53 women, 9 men; average age 56.8 yrs, range 21-94 yrs). Interventions. Patients underwent standard laparoscopic and pelviscopic pro cedures during which intraoperative temperature changes in the insufflation system, abdomen, and rectum were measured. Measurements and Main Results. Carbon dioxide was at room temperature in th e insufflation hose (similar to 23 degrees C. During insufflation, intraabd ominal gas temperature decreased to as much as 27.7 degrees C laverage 32.7 degrees C) depending on length of operation (23 min-5 hrs 8 min), amount o f gas used (12.8-807 L) gas flow (up to 20 L/min), and leakage rate. Preope rative and postoperative temperature comparisons showed no decline in recta l temperature (average +0.18 degrees C) because warming equipment was suffi cient. Conclusion. The decrease in intraoperative intraabdominal gas temperature i s remarkable and can potentially harm the patient. It can be limited by res tricting gas flow and leakage. In operations longer than I hour, substantia l core body temperature drop should be prevented with appropriate heating a nd hydration devices. An insufflator with internal gas heating (Snowden & F encer) had no significant clinical effect.