Influence of nitrous oxide anesthesia on venous gas embolism with carbon dioxide and helium during pneumoperitoneum

Abstract

Background: Gas embolism is a potential hazard during laparoscopic procedures. The aim of this study was to evaluate the effects of nitrous oxide (N₂O) inhalation in the case of gas embolism with carbon dioxide (CO₂) and helium during pneumoperitoneum.

Methods: For this study, 20 anesthetized pigs were ventilated with N₂O (67% inspired) in O₂ (n= 10) or with halothane (0.7–1.5 inspired) in O₂ (n= 10). In each group, CO₂ (n= 5) or helium (n= 5) pneumoperitoneum was established and gas embolism induced at different rates (CO₂ at 0.5, 1, or 2 ml/kg/min; helium at 0.025, 0.05, or 0.1 ml/kg/min) through the left femoral vein a maximum of 10 min while all hemodynamic parameters were continuously monitored.

Results: In the CO₂ group without N₂O, all the animals tolerated rates of 0.5 and 1 ml/kg/min over the 10 min, whereas only 3 of 4 animals in the CO₂ group with N₂O tolerated a rate of 0.5 ml/kg/min, and 2 of 4 animals a rate of 1 ml/kg/min. In the helium group without N₂O, all the animals tolerated gas embolism at all rates, whereas in the helium group with N₂O, 4 of 5 animals needed to be resuscitated at a rate of 0.1 ml/kg/min and one death occurred.

Conclusions: Inhalation of N₂O worsens the negative cardiovascular effects of venous CO₂ or helium gas emboli and increases the risk of emboli-induced death when CO₂ or helium are used to establish pneumoperitoneum. The volume of venous venous helium gas emboli causing such effects is substantially smaller than that for venous CO₂ gas emboli.