Is Carbon Monoxide Poisoning a Risk During Prolonged Laparoscopic Surgery?

We evaluated whether prolonged laparoscopic procedures performed with high-flow carbon dioxide (CO2) insufflation, intensive evacuation of intraabdominal smoke, and controlled hyperventilation with 50% to 90% oxygen results in significant elevation in blood carboxyhemoglobin levels. Twenty-seven healthy, nonsmoking women (mean ± SD age 39.1 ± 8.0 yrs, range 22-56 yrs) undergoing laparoscopic procedures in which smoke was generated participated. In all cases both the CO2 laser and bipolar electrosurgery were used extensively. The mean ± SD duration of surgery was 141 ± 72 minutes (range 45-300 min). Blood samples were drawn before and after surgery. Carboxyhemoglobin concentrations were measured using a highly accurate gas chromatography method. The mean ± SD carboxyhemoglobin levels were 0.70% ± 0.15% (range 0.44-1.20%) before and 0.58% ± 0.20% (range 0.30-1.33%) after surgery. The concentrations decreased significantly during surgery (mean ± SD 20% ± 11%, range 3-46%, p <0.001). In only one woman the level increased at the end of surgery. This also occurred when levels exceeded 1% (1.33%). The correlation coefficient (r) between carboxyhemoglobin concentrations and duration of surgery was 0.324. We concluded that carbon monoxide poisoning is not associated with prolonged laparoscopic surgical procedures. This may be attributed to aggressive smoke evacuation that minimized exposure and to elimination of CO2 through hyperventilation.