Laparoscopic surgery and carbon monoxide toxicity - Tips from Other Journals

Author: Anne D. Walling
Date: Feb 15, 1997

The use of laser or electrosurgery in an atmosphere of carbon dioxide during laparoscopic surgery generates significant amounts of carbon monoxide, which is readily absorbed from the peritoneum. This could result in the formation of carboxyhemoglobin, with a theoretic danger of sublethal carbon monoxide poisoning. Nezhat and colleagues studied women undergoing prolonged laparoscopic surgery to evaluate whether the procedure significantly elevated their blood levels of carbon monoxide.

The study included 27 patients who ranged in age from 26 to 52 years (mean age: 39 years) and were healthy nonsmokers. The patients were scheduled for hysterectomy (six patients), adhesiolysis (seven patients), ablation of endometriosis (five patients), cystectomy (three patients), myomectomy (three patients), and one case each of colectomy, salpingo-oophorectomy and presacral neurectomy. The median duration of surgery was 150 minutes. Blood samples were obtained during induction of anesthesia and within 10 minutes after surgery.

The blood concentration of carboxyhemoglobin was significantly reduced in all but one of the patients following surgery. The reduction ranged from 3 percent to 46 percent (mean: 20 percent). Even in the single patient who demonstrated an increase, the level of carboxyhemoglobin did not exceed the human threshold tolerance of 2 percent.

The authors attribute the lack of evidence for elevation of carboxyhemoglobin during laparoscopic surgery to the policy of aggressive evacuation of smoke from the abdominal cavity and their system of anesthesia. Patients were ventilated with high concentrations of oxygen without nitrous oxide, and a state of controlled hyperventilation was maintained in order to maximize excretion of carbon dioxide. They conclude that, using their protocols, prolonged laparoscopic surgery is not associated with risk of carbon monoxide toxicity.

Nezhat C, et al. The risk of carbon monoxide poisoning after prolonged laparoscopic surgery. Obstet Gynecol 1996; 88:771-4.

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