Physiological Effects of Pneumoperitoneum

Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats

“…Laparoscopic access, in turn, is associated with decreased pain, lower morbidity, superior cosmesis, shorter postoperative stay and return to preoperative activities as compared with open techniques [2][3][4][5] . Carbon dioxide (CO 2 ) is the gas employed most widely for insufflation, given that it is noncombustible, relatively inexpensive and highly soluble in blood, minimizing the risk of embolism [2][3]6 . However, PP increases intra-abdominal pressure, which has been shown to produce oliguria and renal dysfunction in both animal and clinical studies [1][2][4][5][6][7][8][9][10][11][12] .…”

“…However, PP increases intra-abdominal pressure, which has been shown to produce oliguria and renal dysfunction in both animal and clinical studies [1][2][4][5][6][7][8][9][10][11][12] . In healthy young patients, these changes tend to be mild and reversible due to the various physiologic mechanisms for CO 2 buffering and elimination 2,12 . Therefore, no major clinical consequences are observed.…”

“…Therefore, no major clinical consequences are observed. In patients with underlying renal impairment, however, these renal effects may be of clinical significance, thus increasing the morbidity of the procedure [2][3]7,12 . This situation is becoming common due to widespread use of laparoscopic techniques, which were formerly restricted to "optimal" candidates but are currently used in an increasing number of patients with comorbidities 1-2,8-9 .…”

“…They include persistence of renal changes for some hours after desufflation [1][2]5,[8][9][10][11] , increased renin activity in dogs following CO 2 (but not helium) insufflation 10 and higher vasopressin levels 7,10 , as well as complete oliguria, reversed with N-acetylcysteine 9 or a vasopressin receptor antagonist 7 . Histopathological changes have also been assessed, although they are reported only occasionally in the literature 2,4,11,[13][14][15][16] .…”

“…Histopathological changes have also been assessed, although they are reported only occasionally in the literature 2,4,11,[13][14][15][16] .…”