Insufflation with Humidified and Heated Carbon Dioxide in Short-Term Laparoscopy: A Double-Blinded Randomized Controlled Trial

Abstract

Background. We tested the hypothesis that warm-humidified carbon dioxide (CO2) insufflation would reduce postoperative pain and morphine requirement compared to cold-dry CO2 insufflation. Methods. A double-blinded, randomized, controlled trial was conducted to compare warm, humidified CO2 and cold-dry CO2. Patients with benign uterine diseases were randomized to either treatment (n = 48) or control (n = 49) group during laparoscopically assisted vaginal hysterectomy. Primary endpoints of the study were rest pain, movement pain, shoulder-tip pain, and cough pain at 2, 4, 6, 24, and 48 hours postoperatively, measured by visual analogue scale. Secondary outcomes were morphine consumption, rejected boli, temperature change, recovery room stay, and length of hospital stay. Results. There were no significant differences in all baseline characteristics. Shoulder-tip pain at 6 h postoperatively was significantly reduced in the intervention group. Pain at rest, movement pain, and cough pain did not differ. Total morphine consumption and rejected boli at 24 h postoperatively were significantly higher in the control group. Temperature change, recovery room stay, and length of hospital were similar. Conclusions. Warm, humidified insufflation gas significantly reduces postoperative shoulder-tip pain as well as morphine demand. This trial is registered with Clinical Trial Registration Number DRKS00003853 (German Clinical Trials Register (DRKS)).

Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review

“…The studies all involved laparoscopic operations. Many of the studies had small sample sizes, and only 7 studies had more than 30 patients in each arm [ 22 - 28 ]. Seven studies [ 19 , 23 , 27 , 29 - 32 ] found significantly higher core body temperatures in the treatment group (humidified, warmed CO 2 group) than in the control group (cold, dry CO 2 ) whereas nine studies did not find any significant difference [ 22 , 24 - 26 , 28 , 33 - 36 ].…”

Warmed, humidified CO2 insufflation benefits intraoperative core temperature during laparoscopic surgery: A meta‐analysis

“…A total of 723 papers were identified and entered into a database; 403 were duplicates (same study title appearing in different search results), leaving 320 potentially relevant publications. Thirteen studies met the inclusion criteria and were included in the meta-analysis ( Figure 1) (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). They comprised a total of 796 patients.…”

Prevention of Intraoperative Hypothermia in Laparoscopy by the Use of Body-Temperature and Humidified CO2: a Pilot Study

“…Another recently published randomised study, which additionally used a warm air blower and warm infusions, did not find any significant temperature difference with the use of HumiGard ® . However, this study cannot be used for comparison as the operation times were very short (average of 15 minutes insufflation time 15 .…”