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Warm, humidified carbon dioxide gas insufflation for laparoscopic appendicectomy in children: a double-blinded
Tzu-Chieh Yu1, James K Hamill, Andrew Liley
1Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. wendy.yu@auckland.ac.nz
Insights
Warm, humidified carbon dioxide (CO(2)) insufflation did not improve postoperative pain or recovery in children undergoing laparoscopic appendicectomy. This study found no short-term clinical benefits for this technique in pediatric patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Anesthesiology
Background:
- Conventional carbon dioxide (CO(2)) insufflation in laparoscopic surgery can cause peritoneal desiccation, leading to inflammation and injury.
- Warm, humidified CO(2) gas may prevent desiccation-related peritoneal issues.
- Hypothesis: Reduced peritoneal desiccation improves patient outcomes in pediatric laparoscopic appendicectomy.
Purpose of the Study:
- To evaluate the clinical benefits of warm, humidified CO(2) insufflation.
- To assess its impact on postoperative pain and recovery in children (8-14 years) undergoing acute laparoscopic appendicectomy.
Main Methods:
- Double-blinded, randomized controlled trial with 190 pediatric participants.
- Intervention group: warm (37°C), humidified (98% RH) CO(2) insufflation.
- Control group: standard room temperature (20°C), non-humidified CO(2). Standardized perioperative care and pain assessment using visual analog scales and morphine equivalent daily dosages (MEDD).
Main Results:
- No significant differences in postoperative MEDD or pain scores between groups.
- No variations observed in postoperative recovery parameters or return to normal activities.
- Baseline characteristics were similar between the intervention and control groups.
Conclusions:
- Warm, humidified CO(2) insufflation offers no discernible short-term clinical advantages for postoperative outcomes in pediatric patients undergoing acute laparoscopic appendicectomy.
- The findings do not support the use of this technique to mitigate pain or enhance recovery in this specific patient population.
Objective:
To investigate clinical benefits of warm, humidified carbon dioxide (CO(2)) insufflation for acute laparoscopic appendicectomy on postoperative pain and recovery in children (age 8-14 years).
Background:
Conventional CO(2) insufflation leads to desiccation-related peritoneal inflammation and injury, which is preventable with warm, humidified CO2 gas. We hypothesized that reduced peritoneal desiccation would improve patient-centered outcomes in children after laparoscopic appendicectomy.
Method:
A double-blinded, randomized controlled trial was conducted. Intervention group participants received warm (37°C), humidified (98% relative humidity) CO(2) gas insufflation, whereas control participants received standard room temperature (20°C) gas with 0% relative humidity. Perioperative analgesia and anesthesia were standardized. Postoperative opiate usage was converted to morphine equivalent daily dosages (MEDD) for comparison, and pain intensity at rest and on moving was rated by participants using visual analog scales. Postoperative recovery and return to normal activities was assessed using a questionnaire on day 10.
Results:
Between February 2010 and March 2011, a total of 190 participants were randomized. Both intervention and control groups were matched at baseline. Postoperative MEDD and pain scores were also similar. There were no differences in postoperative recovery parameters.
Conclusions:
Warm, humidified CO(2) insufflation for acute laparoscopic appendicectomy has no short-term clinical benefits on postoperative outcomes in pediatric patients (ClinicalTrials.gov trial identifying code: NCT01027455).
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