Warming and Humidification of Insufflation Co2 in Laparoscopic Colonic Surgery - A Double-Blinded Randomised Controlled Trial

Sammour, Tarik; Kahokehr, A.; Hayes, Julian; Hulme-Moir, Michael; Hill, Andrew

doi:10.1016/j.jss.2009.11.023

Cited by 17 publications

(32 citation statements)

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“…The flow rate was calculated individually and corrected for the weight of each rat based on data from 74 human laparoscopic colonic resections performed in three hospitals in Auckland, New Zealand from May 2008 to June 2009 (37). In this human trial, the median volume of intravenous fluid given to these patients intra-operatively was 2000 mL, the mean duration of surgery was 180 min, and the mean patient weight was 72.4 kg.…”

Section: Intravenous Fluidsmentioning

confidence: 99%

“…The insufflation flow rate was determined individually and corrected for the peritoneal surface area of each rat based on data from 74 human laparoscopic colonic resections (details of the calculation are provided in Figure 2) (37,39,40). The insufflation was continued for a total of 110 minutes (based on the median pneumoperitoneum time from the same clinical trial data) (37).…”

Section: Rat Pneumoperitoneummentioning

confidence: 99%

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Warming and humidification have no effect on oxidative stress during pneumoperitoneum in rats

Sammour

Mittal²,

Delahunt

et al. 2011

Minimally Invasive Therapy & Allied Technologies

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Pneumoperitoneum is reported to induce oxidative stress due to the desiccative effect of cold, dry gas insufflation. The aim of this study is to compare the effect of warmed, humidified insufflation to standard gas, by measuring oxidative stress markers in a physiologically relevant animal model. Twenty male Wistar rats (330?650 g) were alternately assigned to the Warm Humidified group (WH, n = 10) and Control group (n = 10). All rats underwent pneumoperitoneum at 5 mmHg and a controlled flow rate for 110 min. The WH group received warmed (37?C) and humidified (98% Relative Humidity (RH)) gas and the control group received standard gas at room temperature (19?C) and 0% RH. At the end of pneumoperitoneum, samples of liver, kidney, pancreas, jejunum, and lung were excised. Levels of plasma and tissue malondialdehyde (MDA) and protein carbonyls (PC) were measured. Organ light microscopy was performed. There were no differences between groups for MDA or PC concentrations in plasma, liver, kidney, jejunum, or lung tissue. There were no differences in histological score between groups. Warming and humidification of pneumoperitoneum insufflation gas have no effect on measures of oxidative stress compared to non-warmed, non-humidified controls.

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Section: Intravenous Fluidsmentioning

confidence: 99%

Section: Rat Pneumoperitoneummentioning

confidence: 99%

Warming and humidification have no effect on oxidative stress during pneumoperitoneum in rats

Sammour

Mittal²,

Delahunt

et al. 2011

Minimally Invasive Therapy & Allied Technologies

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“…Confirming this theory, animal studies and clinical trials have demonstrated that the duration of POI is significantly decreased in patients undergoing laparoscopic instead of open procedures for colon surgery, in which the abdominal organs are more exposed to manipulation and intraoperative thermal cooling (12, 35, 62). On the other hand, recent studies have shown that there are not significant clinical differences in POI outcomes using warmed humidified laparoscopic gas versus dry cold gas during laparoscopic colectomy and appendectomy (60,75), hypothesizing that thermal changes after main abdominal surgeries may be transitory and that they don't permanently damage the tissue for longer periods.…”

Section: Discussionmentioning

confidence: 99%

Experimental evidence and mathematical modeling of thermal effects on human colonic smooth muscle contractility

Altomare

Gizzi

Guarino

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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It has been shown, in animal models, that gastrointestinal tract (GIT) motility is influenced by temperature; nevertheless, the basic mechanism governing thermal GIT smooth muscle responses has not been fully investigated. Studies based on physiologically tuned mathematical models have predicted that thermal inhomogeneity may induce an electrochemical destabilization of peristaltic activity. In the present study, the effect of thermal cooling on human colonic muscle strip (HCMS) contractility was studied. HCMSs were obtained from disease-free margins of resected segments for cancer. After removal of the mucosa and serosa layers, strips were mounted in separate chambers. After 30 min, spontaneous contractions developed, which were measured using force displacement transducers. Temperature was changed every hour (37, 34, and 31°C). The effect of cooling was analyzed on mean contractile activity, oscillation amplitude, frequency, and contraction to ACh (10(-5) M). At 37°C, HCMSs developed a stable phasic contraction (~0.02 Hz) with a significant ACh-elicited mean contractile response (31% and 22% compared with baseline in the circular and longitudinal axis, respectively). At a lower bath temperature, higher mean contractile amplitude was observed, and it increased in the presence of ACh (78% and 43% higher than the basal tone in the circular and longitudinal axis, respectively, at 31°C). A simplified thermochemomechanical model was tuned on experimental data characterizing the stress state coupling the intracellular Ca(2+) concentration to tissue temperature. In conclusion, acute thermal cooling affects colonic muscular function. Further studies are needed to establish the exact mechanisms involved to better understand clinical consequences of hypothermia on intestinal contractile activity.

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“…Another reason for low core temperature among laparoscopic patients may be attributed to ''cold CO 2 '' pneumoperitoneum. So far, however, the effect of warming and humidification of insufflated carbon dioxide in laparoscopic colonic surgery seems uncertain [32], and other methods of active warming should be explored.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic‐Assisted and Open High Anterior Resection within an ERAS Protocol

et al. 2012

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Warming and Humidification of Insufflation Co2 in Laparoscopic Colonic Surgery - A Double-Blinded Randomised Controlled Trial

Cited by 17 publications

References 0 publications

Warming and humidification have no effect on oxidative stress during pneumoperitoneum in rats

Warming and humidification have no effect on oxidative stress during pneumoperitoneum in rats

Experimental evidence and mathematical modeling of thermal effects on human colonic smooth muscle contractility

Laparoscopic‐Assisted and Open High Anterior Resection within an ERAS Protocol

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