Pulmonary CO2 Elimination During Surgical Procedures Using Intra- or Extraperitoneal CO2 Insufflation

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Abstract
We examined end-tidal CO2 tension (PETCO2) and pulmonary CO2 elimination of CO2 (V̇ECO2) during CO2 insufflation under general anesthesia for three surgical procedures: gynecologic laparoscopy (intraperitoneal CO2 insufflation for 43 ± 4 min), laparoscopic cholecystectomy (intraperitoneal CO2 insufflation for 125 ± 14 min), and pelviscopy (extraperitoneal CO2 insufflation for 45 ± 3 min). All patients (10 in each pup) underwent controlled mechanical ventilation. Oxygen consumption (V̇O2) and V̇ECO2 were measured at 2-min intervals by a system using a mass spectrometer. For the three surgical procedures, V̇O2 remained stable, whereas V̇ECO2 and PETCO2 increased in parallel from the 8th to the 10th min after the start of CO2 insufflation. A plateau was reached 10 min later in patients having intraperitoneal insufflation, whereas V̇ECO2 and PETCO2 continued to increase slowly throughout CO2 insufflation during pelviscopy. During pelviscopy, the maximum increase in V̇ECO2 and PETCO2 (76 ± 5% and 71 ± 7%) was significantly more pronounced than that observed during cholecystectomy (25 ± 4% and 25 ± 4%) and gynecologic laparoscopy (15 ± 3% and 12 ± 2%). The authors conclude that CO2 diffusion into the body is more marked during extraperitoneal than during intraperitoneal CO2 insufflation but is not influenced markedly by the duration of intraperitoneal insufflation.

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