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Laparoscopic pneumoperitoneum in acute peritonitis does not increase bacteremia or aggravate metabolic or hemodynamic
F D Collet e Silva1, R C Ramos, L F Zantut
1University of São Paulo School of Medicine, Department of Surgery, São Paulo, Brazil.
Abstract:
The use of laparoscopy in generalized peritonitis has become increasingly frequent in recent years. However, CO2 pneumoperitoneum in association with increased intraperitoneal pressure may have deleterious effects in patients with hemodynamic or metabolic disturbances caused by bacterial peritonitis. The purpose of this study was to investigate the effect of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances in an animal model of bacterial peritonitis. Dogs were anesthetized, orally intubated, and subjected to experimental peritonitis by intraperitoneal inoculation of a suspension containing Escherichia coli and sterile dog feces. The animals were randomly assigned to two groups: control animals were maintained under anesthesia, and the insufflated animals were subjected to intraperitoneal CO2 insufflation. Bacterial peritonitis provoked the appearance of bacteremia and a significant decrease in mean arterial pressure, pH, bicarbonate, and base deficit. The induction of bacterial peritonitis did not significantly influence pH in the control group and partial pressure of arterial CO2 in either group. Thirty minutes of CO2 pneumoperitoneum did not influence the effect of bacterial peritonitis on the analyzed variables. These results suggest that laparoscopic CO2 pneumoperitoneum does not aggravate bacteremia or metabolic and hemodynamic disturbances induced by bacterial peritonitis.
Insights
Laparoscopic carbon dioxide (CO2) pneumoperitoneum did not worsen bacteremia or hemodynamic and metabolic issues in dogs with bacterial peritonitis. This suggests CO2 insufflation is safe for patients with peritonitis undergoing laparoscopic procedures.
Area of Science:
- Surgical Innovation
- Gastroenterology
- Critical Care Medicine
Background:
- Laparoscopic surgery is increasingly used for generalized peritonitis.
- Carbon dioxide (CO2) pneumoperitoneum may negatively impact hemodynamics and metabolism in peritonitis patients.
- Potential risks of CO2 insufflation in peritonitis require investigation.
Purpose of the Study:
- To evaluate the effects of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances.
- To assess CO2 pneumoperitoneum's impact in an animal model of bacterial peritonitis.
Main Methods:
- Experimental bacterial peritonitis was induced in dogs using Escherichia coli and feces.
- Animals were divided into control and CO2 insufflation groups.
- Hemodynamic and blood gas parameters were monitored.
Main Results:
- Bacterial peritonitis caused bacteremia and decreased mean arterial pressure, pH, bicarbonate, and base deficit.
- CO2 pneumoperitoneum did not significantly alter these variables compared to controls.
- No significant changes in pH or partial pressure of arterial CO2 were observed.
Conclusions:
- Laparoscopic CO2 pneumoperitoneum does not exacerbate bacteremia in bacterial peritonitis.
- CO2 insufflation does not worsen metabolic or hemodynamic disturbances caused by peritonitis.
- Findings support the safety of laparoscopic CO2 pneumoperitoneum in peritonitis cases.