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Comparison of fast and slow CO 2 insufflation on hemodynamic parameters in elective laparoscopic cholecystectomy
Raheef Pazhaya Pattillath1, Naiji S James2, Ramesh Rajan1
1Department of Surgical Gastroenterology, Medical College, Thiruvananthapuram, Kerala, India.
Introduction:
Laparoscopic cholecystectomy (LC) uses carbon dioxide (CO 2 ) insufflation to create pneumoperitoneum, which can affect haemodynamic stability. This study compares the effects of fast versus slow CO 2 insufflation on haemodynamic parameters and post-operative pain in elective LC patients.
Patients And Methods:
An observational study was conducted on American Society of Anestheisology category 1/2 patients undergoing elective LC from October 2023 to August 2024, consecutively assigned to Group A (slow insufflation, 2-4 L/min) or Group B (fast insufflation, 8-10 L/min). Intraoperative monitoring of mean arterial pressure (MAP), heart rate (HR) and end-tidal CO 2 was performed immediately after induction of anaesthesia. Post-operative pain was assessed using the Visual Analogue Scale, with the first reading recorded 4 hours after extubation, followed by two additional readings taken at 12-hour intervals thereafter.
Results:
Sixty-eight patients were analysed. Fast insufflation led to higher HRs at several time points and higher MAP at T4 and T5. Post-operative shoulder pain was more frequent with fast insufflation at 4 h ( P = 0.001) and 12 h after the 1 st reading ( P = 0.002). No significant complications were noted in either group.
Conclusion:
Fast CO 2 insufflation resulted in higher HRs, MAPs at certain time intervals, increased post-operative shoulder pain and surgical site pain at 4 h, while other haemodynamic parameters and surgical site pain at two subsequent 12-h intervals were comparable.
