Comparison of immunologic and physiologic effects of CO₂ pneumoperitoneum at room and body temperatures

Abstract

Background: Prolonged and complex laparoscopic procedures expose patients to large volumes of cool insufflation gas. The aim of this study was to compare the effects of a conventional room temperature carbon dioxide (CO₂) pneumoperitoneum with those of a body temperature pneumoperitoneum.

Methods: Patients were randomized to undergo laparoscopic cholecystectomy with a CO₂ pneumoperitoneum warmed to either body temperature (n= 15) or room temperature (n= 15). The physiologic and immunologic effects of warming the gas were examined by measuring peroperative core and intraperitoneal temperatures, peritoneal fluid cytokine concentrations, and postoperative pain.

Results: The mean duration of surgery was 32 min in both groups. Core temperature was reduced in the room temperature group (mean, 0.42°C; p < 0.05). No reduction in temperature occurred when the gas was warmed. Greater levels of cytokines were detected in peritoneal fluid from the room temperature insufflation group tumor necrosis factor alpha (TNF-α): mean, 10.9 pg/ml vs. 0.42, p < 0.05; interleukin 1 beta (IL-1β): mean, 44.8 pg/ml vs. 15.5, p < 0.05; and IL-6: mean, 60.4 ng/ml vs. 47.2. There was no difference in postoperative pain scores or analgesia consumption between the two groups.

Conclusions: The authors conclude that intraoperative cooling can be prevented by warming the insufflation gas, even in short laparoscopic procedures. In addition, warming the insufflation gas leads to a reduced postoperative intraperitoneal cytokine response.