Experimental study of effect of embolism of different laparoscopy insufflation cases

Background ann Purpose: Whilst carbon dioxide is the gas generally used for insufflation during laparoscopy, several studies have reported adverse eff ects specifically associated with its use. These effects may be attributabl e to chemical, metabolic, or immunologic effects specific to CO2. Because h elium is chemically, physiologically, and pharmacologically inert, it has b een suggested as a possible substitute insufflation gas. However, there has been concern about the potential implications of venous gas embolism durin g helium insufflation. The aim of this study was to examine the physiologic al effect of the intravenous injection of He and CO2 in an experimental mod el. Materials and Methods: Eleven domestic white pigs were randomly allocated t o receive multiple intravenous Injections of increasing volumes of either C O2 or He gas. Cardiorespiratory function was measured, and the intravenous volumes of gas that resulted in cardiac arrest were determined. Result: Cardiorespiratory functional measures returned to normal quicker af ter CO2 than after He injection. Helium injection quickly overwhelmed the a nimal's ability to compensate and resulted in death at a lower volume than did CO2 injection. Conclusions: Gas embolism during He insufflation is more likely to be letha l than is CO2 embolism. This scenario is most likely following Veress needl e insertion into a large vein. Therefore, if He is to be used for insufflat ion during clinical laparoscopy, the possibility of venous injection should be minimized by avoiding Veress needle use. Further investigation of the s afety of He insufflation is warranted before a role during clinical laparos copy can be recommended.