Stress responses during laparoscopy with CO2 insufflation and with mechanical elevation of the abdominal wall

Study Objective. To compare the intensity of stress responses caused by lap aroscopy combined with CO2 insufflation (CI) with those caused by mechanica l elevation of the abdominal wall (MEA). Design. Prospective study (Canadian Task Force classification I). Setting, Tertiary care university hospital. Patients. Thirty-one women. intervention. Laparoscopy, 16 with CI and 15 wi th MEA. Measurements and Main Results, Circulating levels of norepinephrine, epinep hrine, cortisol, and interleukin (IL)-6 were compared in the two groups. Ar terial partial pressure of CO2 (PaCO2) did not increase during laparoscopy by either med,od. Plasma norepinephrine and epinephrine levels increased af ter extubation in the MEA group but not in the CI group. Circulating cortis ol levels in both groups increased during laparoscopy; mean intraoperative levels were higher in the CI group. Serum IL-6 levels increased after extub ation in the MEA but not the CI group. Mean heart rate increased during lap aroscopy in both groups, whereas blood pressure increased only in the CI gr oup. More patients in the MEA group required postoperative analgesia. Conclusion. Laparoscopy with MEA caused more pronounced adrenosympathetic a nd cytokine responses than that with CI when PaCO2 was maintained within th e range of normocapnia.