Prospective comparison of helium versus carbon dioxide pneumoperitoneum

Background: During prolonged laparoscopic operations with carbon dioxide (CO₂) pneumoperitoneum (PP), hypercapnia with significant acidosis has been reported to occur in some patients with pulmonary dysfunction. An alternate inert insufflation gas like helium (He) could avoid this problem. Methods: This prospective, IRB-approved study compared the cardiopulmonary response in 20 patients with both CO₂ and He PP. With the minute ventilation held constant, baseline arterial blood gases and ventilatory and cardiac parameters were obtained after anesthetic induction but prior to CO₂ PP. All values were repeated at 20 to 30 and 40 to 60-minute intervals after the insufflation of CO₂ PP, then again during He PP. Values were compared by a paired t test analysis. Results: Patients experienced significant hypercapnia during CO₂ PP when compared with baseline arterial blood gases, but all values returned to baseline levels during He PP. Conclusions: He PP is an effective alternative to CO₂ PP for a laparoscopic cholecystectomy avoiding CO₂ retention and subsequent acidosis. Carbon dioxide retention may be dangerous in patients with pulmonary dysfunction who undergo laparoscopy.