Abdominal Insufflation Exposure

CO2 is the primary gas used to create a pneumoperitoneum for laparoscopy in nonpregnant and pregnant patients. Gaseous carbon dioxide exchange occurs with intraperitoneal insufflation. There has been much concern in the past over the effects of CO2 pneumoperitoneum on the fetus. While studies have demonstrated that fetal acidosis does occur in animal models during CO2 pneumoperitoneum, there have been no long-term adverse effects noted (56-58). Furthermore, there is no evidence to support detrimental effects resulting from CO2 pneumoperitoneum in humans (55). In the pregnant ewe model, observation has been made that CO2 pneumoperitoneum

CO2 insufflation has been used almost exclusively for abdominal exposure in the reported cases of successful laparoscopy during pregnancy. Pneumoperitoneum created with CO2 appears to be safe when abdominal pressures are kept below 15 mmHg and physiologic end tidal CO2 levels are maintained (30-40 mmHg).

results in a PaCO2 to ETCO2 gradient of 16-25 mmHg leading to fetal hypercapnia, hypertension, acidosis, and tachycardia (56,59). Although several studies have demonstrated that the fetus is slightly more acidotic than the mother and that EtCO2 values lag behind corrections in PaCO2, others have observed no change in fetal PaCO2 when maternal sheep PaCO2 was maintained within 37 ± 3.3 mmHg following CO2 insufflation as well as a good correlation between PaCO2 and EtCO2 (56,58,60-62).

CO2 insufflation has been used almost exclusively for abdominal exposure in the reported cases of successful laparoscopy during pregnancy. Pneumoperitoneum created with CO2 appears to be safe when abdominal pressures are kept below 15 mmHg and physiologic end tidal CO2 levels are maintained (30-40mmHg) (12,13). 2

While there is no conclusive evidence in humans that CO2 pneumoperitoneum is detrimental to the fetus, the concern has led to a search for alternative means of intraabdominal exposure during laparoscopy. Gasless laparoscopy has been described using a mechanical abdominal wall lifting device and has been used for the management of ovarian cysts during early pregnancy with good success (63).

Imperative to fetal well-being during laparoscopy is tight control of maternal hemodynamic and respiratory function in order to maintain a normal maternal pH.

Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook


Post a comment