Ideally which gas is used for laproscopy?
ANSWER: (C) CO2REF: Schwartz's Principles of Surgery 9th ed chapter 14, Mastery of endoscopic and laparoscopic surgery edited by Nathaniel J. Soper, Lee L. Swanstrom, W. Stephen Eubanks 3rd ed page 7, Palanivelus Text Book of Surgical Laparoscopy 1st ed page 21"Laparoscopic surgery is most commonly performed with carbon dioxide pneumoperitoneum, because it is cheap, does not support combustion, and is rapidly eliminated from the body, decreasing the risk of gaseous embolism"The unique feature of laparoscopic surgery is the need to lift the abdominal wall from the abdominal organs. Two methods have been devised for achieving this. The first, used by most surgeons, is a pneumoperitoneum.I Pneumoperitoneum1. Air pneumoperitoneum:* Throughout the early twentieth century, intraperitoneal visualization was achieved by inflating the abdominal cavity with air, using a sphygmomanometer bulb.* The problem with using air insufflation is that nitrogen is poorly soluble in blood and is slowly absorbed across the peritoneal surfaces. Air pneumoperitoneum was believed to be more painful than nitrous oxide (N2O) pneumoperitoneum, but less painful than carbon dioxide (COO2) pneumoperitoneum.2. N2O pneumoperitoneum* N2O had the advantage of being physiologically inert and rapidly absorbed.Local affectsSystemic effectsPeritoneal distentionVagal reactionElevated diaphragmAltered venous returnPainHypercartwaAddosisIncreased aftertoadIncreased catecholaminesMyocardial stressIt also provided better analgesia for laparoscopy performed under local anesthesia when compared with CO2 or airDespite initial concerns that N2O would not suppress combustion, controlled clinical trials have established its safety within the peritoneal cavity, (controvertial)In addition, N2O has been shown to reduce the intraoperative end-tidal CO2 and minute ventilation required to maintain homeostasis when compared to CO2 pneumoperitoneum.3. CO2..pneumoperitoneumThe physiologic effects of CO2 pneumoperitoneum can be divided into two areas: (a) gas-specific effects and (b) pressure-specific effectsII. Abdominal lift device:In some situations, minimally invasive abdominal surgery should be performed without insufflation. This has led to the development of an abdominal lift device that can be placed through a 10- to 12-mm trocar at the umbilicus. These devices have the advantage of creating little physiologic derangement, but they are bulky and intrusive.
NO
N2O
CO2
AIR
Peritoneum