Effects of pneumoperitoneum with helium on hemodynamics and oxygen transport: a comparison with carbon dioxide

Pneumoperitoneum with CO2 is associated with adverse effects, such as hypercarbia, arrhythmias, and circulatory depression, which may limit its use in patients with underlying disease. Some of these effects may be caused by CO2 absorption resulting in acid-base disturbances. Laparoscopic insufflation with helium may be a good alternative for CO2, since it is chemically inert. Because there are few data on the use of helium for laparoscopy, we studied hemodynamics and gas exchange during insufflation with CO2 or helium in 8 pigs at 10, 15, and 20 mm Hg intraabdominal pressure. Heart rate did not change significantly with both gases. Arterial blood pressure increased with CO2 (p < 0.05) but not with helium. Cardiac output, mixed venous oxygen saturation, and oxygen consumption did not decrease, whereas central venous filling pressures increased during insufflation with either gas. Insufflation with CO2 resulted in mild increases in arterial, central venous, and end-expiratory CO2. The results suggest that pneumoperitoneum with helium will not be associated with profound circulatory depression or oxygen transport abnormalities. In addition, the use of helium is not associated with acid-base disturbances, although central venous filling pressures are similarly increased as with the use of CO2 pneumoperitoneum.