Effects of Pneumoperitoneum with Helium on Hemodynamics and Oxygen Transport: A Comparison with Carbon Dioxide

Abstract

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.