Hemodynamic and metabolic effects of nitrous oxide and carbon dioxide insufflation in laparoscopic repair of inguinal hernias
Fahrettin Acar1, Dr. Faruk Aksoy1, Metin Belviranlı1, Sema Tuncer2
1Selçuk Üniversitesi Tıp Fakültesi Meram Tıp Fakültesi Genel Cerrahi Anabilim Dalı, KONYA
2Selçuk Üniversitesi Tıp Fakültesi Meram Tıp Fakültes Anesteziyoloji ve Reanimasyon Anabilim Dalı, KONYA
Purpose: The aim of this study is to compare hemodynamic and metabolic effects of CO2 and N2O insufflation into extraperitoneal area.
Background: In treatment of inguinal hernia, a laparoscopic technique is widely applied to total extraperitoneal hernia (TEP) in some clinics. Due to the fact that CO2 used in the extraperitoneal area contains higher hypercarbia and acidosis compared to N2O, this leads to search for alternative gas in this area. Materials and Methods: Between September 2003 and July 2004, 24 male patients who underwent one-sided inguinal hernia operation with TEP under general standard anaesthesia, have participated in this study. We used CO2 for insufflation in 12 patients (mean age; 42±18 years) and N2O in 12 patients (mean age; 46±16 years). Prolen greft was used in both groups during repair and, throughout the operation, hemodynamic and metabolic parameters were recorded at 0, 5, 15, 30, and 45th minutes.
Results: Parameters obtained from these two groups such as heart rate (HR), partial CO2 pressure (PaCO2), end-tidal CO2 pressure (PETCO2), mean arterial pressure (MAP), and total gas amount insuffleted during operation were found to be significantly higher in the CO2 group than in the N2O group (p<0,001). In contrast; pH, O2 saturation (SpO2), and partial O2 pressure (PaO2) were determined as lower in CO2 group than in N2O group throughout the operation (p<0,001). Furthermore, visual pain score (VPS) was significantly lower in N2O group. Between the two groups, no major difference was observed in terms of endtidal N2O pressure (PETN2O).
Conclusion: In the laparoscopic interventions, N2O insufflation to the extraperitoneal area does not lead to the hemodynamic and metabolic changes, whereas CO2 insufflation has detrimental effect on hemodynamic levels by causing hypercarbia and acidosis. Moreover, in the postoperation period, VPS was lower in members of the N2O insufflated group than those in the CO2 insufflated group. Consequently, in the laparoscopic surgery, during extraperitoneal inguinal hernia repairment, N2O gas has more advantage than CO2 gas.
Keywords: Carbon dioxide insufflation, Nitrous oxide insufflation, Laparoscopic inguinal hernia repair.