Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-24T06:56:02.288Z Has data issue: false hasContentIssue false
  • English
  • Français

Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication?

Published online by Cambridge University Press:  23 December 2004

M. Soro ,
M. L. García-Pérez ,
R. Ferrandis ,
G. Aguilar  and
F. J. Belda
M. Soro
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
M. L. García-Pérez
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
R. Ferrandis
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
G. Aguilar
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
F. J. Belda
Affiliation:
Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
Get access

Abstract

Summary

Background and objective: One of the complications of laparoscopic surgery is carbon monoxide production during electrocautery. The aim of our study was to ascertain the relationship between intraperitoneal and alveolar concentrations of carbon monoxide and systemic carboxyhaemoglobin in patients undergoing laparoscopic cholecystectomy and anaesthetized with a closed system, where the carbon monoxide excreted through the lungs is accumulated in the circuit and thus re-inhaled.

Methods: Nine consecutive patients undergoing laparoscopic cholecystectomy were studied. Patients' lungs were ventilated with a closed anaesthesia breathing system (Physioflex®). Measurements were taken after establishing pneumoperitoneum (baseline) and at 5, 15 and 30 min after starting electrocautery.

Results: Mean duration of pneumoperitoneum was 42 ± 13 min with cumulative electrocautery time of 2.4 ± 1.8 min. Intraperitoneal carbon monoxide concentrations increased significantly at 5, 15 and 30 min reaching peak values of 481 ± 151 ppm at 15 min. No significant differences were found in alveolar carbon monoxide and carboxyhaemoglobin concentrations with respect to baseline.

Conclusions: No significant increase in carboxyhaemoglobin is produced during laparoscopic surgery, even under closed-system anaesthesia without pulmonary carbon monoxide elimination. This is most likely due to a low peritoneal absorption of carbon monoxide. We conclude that in adult patients, no carbon monoxide intoxication is caused if reasonable periods of electrocautery are used and the intraperitoneal gas is regularly renewed.

Keywords

ANAESTHESIA, closed-systemCARBON MONOXIDELAPAROSCOPYGENERAL ANAESTHESIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 483 - 488
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy: anesthetic implications. Anesth Analg 1993; 76: 1120–1133.Google Scholar
Esper E, Russell TE, Coy B, Duke IIIBE, Max MH, Coil JA. Transperitoneal absorption of thermocautery-induced carbon monoxide formation during laparoscopic cholecystectomy. Surg Laparosc Endosc 1994; 4: 333–335.Google Scholar
Wu JS, Monk T, Luttmann DR, Meininger TA, Soper NJ. Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic cholecystectomy. J Gastrointest Surg 1998; 2: 399–405.Google Scholar
Beebe DS, Swica H, Carlson N, Palahniuk RJ, Goodale RL. High levels of carbon monoxide are produced by electrocautery of tissue during laparoscopic cholecystectomy. Anesth Analg 1993; 77: 338–341.Google Scholar
Ott DE. Carboxyhaemoglobin due to peritoneal smoke absorption from laser tissue combustion at laparoscopy. J Clin Laser Med Surg 1998; 16: 309–315.Google Scholar
Meredith T, Vale A. Carbon monoxide poisoning. BMJ 1988; 296: 71–79.Google Scholar
Rendell-Baker L. Future directions in anesthesia apparatus. In: Eisenkraft JB, ed. Anesthesia Equipment. Principles and Applications. Chicago, USA: Mosby-Yearbook Inc, 1993: 691–694.
Rosin LD. Laparoscopic cholecystectomy. In: Zinner MJ, ed. Maingot's Abdominal Operations. Connecticut, New York, USA: Appleton & Lange, 1997: 1855–1865.
Cotes JE. Exchange of gas in the lung. In: Cotes JE, ed. Lung function, 5th edn. Oxford, UK: Blackwell Scientific, 1993: 263–298.
Tyuma Y, Ueda Y, Imaizumi K, Kosaka H. Prediction of the carboxyhemoglobin levels during and after carbon monoxide exposures in various animal species. Jap J Physiol 1981; 31: 131–143.Google Scholar
Nezhat C, Seidman DS, Vreman HJ, Stevenson DK, Nezhat F, Nezhat C. The risk of carbon monoxide poisoning after prolonged laparoscopic surgery. Obstet Gynecol 1996; 88: 771–774.Google Scholar
Cathleen C, Toby L. Poisoning. In: Shoemaker WC, Ayres S, Grenvik A, Holbrook PR, Thompson WL, eds. Textbook of Critical Care, 3rd edn. Pennsylvania, USA: Saunders, 1995: 1186–1210.
Versichelen L, Rolly G, Vermeulen H. Accumulation of foreign gases during closed-system anaesthesia. Br J Anaesth 1996; 76: 668–672.Google Scholar
Moon R. Cause of poisoning relation to halogenated agents still not clear. Anesth Patient Safety Found Newslett 1994; 9: 13–16.Google Scholar
Peterson JE, Stewart RD. Absorption and elimination of carbon monoxide by inactive young men. Arch Environ Health 1970; 21: 165–171.Google Scholar
Strunin I. The splanchnic, hepatic and portal circulations. In: Prys-Roberts C, ed. The Circulation in Anaesthesia.Oxford, UK: Blackwell Scientific, 1980: 241–251