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Human Reproduction, Vol. 17, No. 6, 1623-1629, June 2002
© 2002 European Society of Human Reproduction and Embryology

Reduction of CO2-pneumoperitoneum-induced metabolic hypoxaemia by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. A preliminary study

Ospan A. Mynbaev1,4,5, Carlos R. Molinas1, Leila V. Adamyan4, Bernard Vanacker3 and Philippe R. Koninckx1,2

1 Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, 2 The Department of Obstetrics and Gynaecology, 3 The Department of Anaesthesiology, University Hospital Gasthuisberg, Leuven, Belgium and 4 The Department of Operative Gynaecology, Scientific Centre for Obstetrics, Gynaecology and Perinatalogy, Russian Academy of Medical Sciences, Moscow, Russia

BACKGROUND: CO2-pneumoperitoneum used in endoscopic surgery induces system effects by CO2 absorption. This study investigated the effect of the addition of O2 to CO2-pneumoperitoneum, upon CO2 absorption. METHODS: The effect of a pneumoperitoneum using 100% CO2 or 94% CO2 + 6% O2 upon arterial blood gases, acid base and O2 homeostasis was evaluated. In series A suboptimal ventilation and a pneumoperitoneum pressure (PP) of 10 mmHg was used. In series B adequate ventilation and PP of 6 mmHg was used. RESULTS: CO2-pneumoperitoneum profoundly affected blood gases and acid base homeostasis i.e. increasing pCO2, HCO3(P < 0.001) and lactate concentrations (P < 0.05) and decreasing pH, actual base excess and standard bicarbonate (P < 0.001), resulting in metabolic hypoxaemia with desaturation, lower pO2 (P < 0.001) and O2Hb (P < 0.05). These effects were more pronounced with higher PP and suboptimal ventilation. CONCLUSION: CO2-pneumoperitoneum profoundly affected blood gases and acid base homeostasis resulting in metabolic hypoxaemia. The addition of 6% of O2 to the CO2-pneumoperitoneum prevented these effects to a large extent. If these preliminary data are confirmed in the human, the addition of a few percent of O2 to CO2 could become important for endoscopic surgery of long duration, especially in obese patients with limited cardiorespiratory adaptation and steep Trendelenburg.

Key words: acidosis/carboxaemia/CO2-pneumoperitoneum/metabolic hypoxaemia/oxygen

5 To whom correspondence should be addressed at: Centre for Surgical Technologies K.U. Leuven, Minderbroederstraat 17, B-3000, Leuven, Belgium. E-mail: ospanmynbaev{at}hotmail.com


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