ALTERNATIVES TO CARBON DIOXIDE PNEUMOPERITONEUM

Newer approaches are being investigated to reduce pathophysiologic consequences of CO₂ pneumoperitoneum.

2295

Inert Gases

Insufflation of inert gas (e.g., helium, argon) instead of CO₂ avoids the increase in PaCO₂ from absorption. ^{[243] [244]} Consequently, hyperventilation is not required,^{[33] [35] [245] [246]} although the ventilatory consequences of the increased IAP persist. The hemodynamic changes produced by pneumoperitoneum using inert gas are similar to those observed with CO₂ . However, the use of these gases accentuates the decrease in cardiac output, whereas the increase in arterial pressure is attenuated.^{[35] [246] [247]} Peritoneal insufflation of CO₂ , even in the absence of hypercapnia, apparently stimulates the cardiovascular system and subsequently partially corrects the hemodynamic repercussions due to increased IAP.^[72] Unfortunately, the low blood solubility of the inert gases raises the issue of safety in the event of gas embolism.^{[248] [249]}