Prospective comparison of helium versus carbon dioxide pneumoperitoneum.

Background: During prolonged laparoscopic operations with carbon dioxide (CO2) pneumoperitoneum (PP), hypercapnia with significant acidosis has been reported to occur in some patients with pulmonary dysfunction. An alternate inert insufflation gas like helium (He) could avoid this problem.

Methods: This prospective, IRB-approved study compared the cardiopulmonary response in 20 patients with both CO2 and He PP. With the minute ventilation held constant, baseline arterial blood gases and ventilatory and cardiac parameters were obtained after anesthetic induction but prior to CO2 PP. All values were repeated at 20 to 30 and 40 to 60-minute intervals after the insufflation of CO2 PP, then again during He PP. Values were compared by a paired t test analysis.

Results: Patients experienced significant hypercapnia during CO2 PP when compared with baseline arterial blood gases, but all values returned to baseline levels during He PP.

Conclusions: He PP is an effective alternative to CO2 PP for a laparoscopic cholecystectomy avoiding CO2 retention and subsequent acidosis. Carbon dioxide retention may be dangerous in patients with pulmonary dysfunction who undergo laparoscopy.