Severe portal and systemic acidosis during CO2-laparoscopy compared to helium or gasless laparoscopy and laparotomy in a rodent model: an experimental study

• Published in: Surgical endoscopy Vol. 36; no. 7; pp. 4701 - 4711
• Main Authors: Inderbitzin, Devdas T., Mueller, Tobias U., Marti, Grischa, Eichenberger, Simone, Fellay, Benoît, Magnin, Jean-Luc, Kraehenbuehl, Lukas
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Acidosis; Blood gas analysis; Carbon dioxide; Gastroenterology; Gynecology; Hepatology; Hyperventilation; Laparoscopy; Laparotomy; Medicine; Medicine & Public Health; Physiology; Proctology; Surgery; Insufflation pressure; Blood gases; Laparoscopy; Insufflation gas; Acidosis
• DOI: 10.1007/s00464-021-08810-6
• EISSN: 1432-2218
• ISSN: 0930-2794

Background and aims
This experimental study assesses the influence of different gases and insufflation pressures on the portal, central-venous and peripheral-arterial pH during experimental laparoscopy.
Methods
Firstly, 36 male WAG/Rij rats were randomized into six groups (
n
 = 6) spontaneously breathing during anaesthesia: laparoscopy using carbon dioxide or helium at 6 and 12 mmHg, gasless laparoscopy and laparotomy. 45 and 90 min after setup, blood was sampled from the portal vein, vena cava and the common femoral artery with immediate blood gas analysis. Secondly, 12 animals were mechanically ventilated at physiological arterial pH during 90 min of laparotomy (
n
 = 6) or carbon dioxide laparoscopy at 12 mmHg (
n
 = 6) with respective blood gas analyses.
Results
Over time, in spontaneously breathing rats, carbon dioxide laparoscopy caused significant insufflation pressure-dependent portal acidosis (pH at 6 mmHg, 6.99 [6.95–7.04] at 45 min and 6.95 [6.94–6.96] at 90 min, pH at 12 mmHg, 6.89 [6.82–6.90] at 45 min and 6.84 [6.81–6.87] at 90 min;
p
 < 0.05) compared to laparotomy (portal pH 7.29 [7.23–7.30] at 45 min and 7.29 [7.20–7.30] at 90 min;
p
 > 0.05). Central-venous and peripheral-arterial acidosis was significant but less severely reduced during carbon dioxide laparoscopy. Laparotomy, helium laparoscopy and gasless laparoscopy showed no comparable acidosis in all vessels. Portal and central-venous acidosis during carbon dioxide laparoscopy at 12 mmHg was not reversible by mechanical hyperventilation maintaining a physiological arterial pH (pH portal 6.85 [6.84–6.90] (
p
 = 0.004), central-venous 6.93 [6.90–6.99] (
p
 = 0.004), peripheral-arterial 7.29 [7.29–7.31] (
p
 = 0.220) at 90 min; Wilcoxon–Mann–Whitney test).
Conclusion
Carbon dioxide laparoscopy led to insufflation pressure-dependent severe portal and less severe central-venous acidosis not reversible by mechanical hyperventilation.