This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Diemunsch, P. A. Articles by Van Dorsselaer, A. Search for Related Content PubMed PubMed Citation Articles by Diemunsch, P. A. Articles by Van Dorsselaer, A.

---

GENERAL ARTICLES

Nitrous Oxide Fraction in the Carbon Dioxide Pneumoperitoneum During Laparoscopy Under General Inhaled Anesthesia in Pigs

Pierre A. Diemunsch, MD^*, Klaus D. Torp, MD, Thomas Van Dorsselaer^*, Didier Mutter, , MD, PhD^*, Anne M. Diemunsch, PhD^*, Roland Schaeffer, MD^*, Gérard Teller, PhD, and Alain Van Dorsselaer, PhD

*I.R.C.A.D., Hôpitaux Universitaires, Strasbourg, France; Mayo Clinic Jacksonville, Jacksonville, Florida; and L.S.M.B.O., Faculté de Chimie, Strasbourg, France

Address correspondence and reprint requests to P. A. Diemunsch, MD, I.R.C.A.D., Hôpitaux Universitaires, 1, Place de l’Hôpital, 67000 Strasbourg, France.

During prolonged laparoscopy, the diffusion of other gases in the carbon dioxide (CO₂) pneumoperitoneum may lessen its safety. Nitrous oxide (N₂O)/CO₂ gas mixtures may become hazardous with regard to gas embolization and fire risk. We therefore evaluated the kinetics of pneumoperitoneal intrusion of N₂O. In five anesthetized domestic pigs, controlled ventilation, with an initial fraction of inspired oxygen = 1.0, was adjusted to keep ETCO₂ pressure between 35 and 45 mm Hg. The peritoneum was insufflated with CO₂ to a pressure of 12 mm Hg, which was maintained throughout the procedure. T0 was defined as the time when N₂O was introduced in the breathing circuit (N₂O end-tidal fraction = 66%). Gas samples (10 mL) from the pneumoperitoneum were analyzed every 10 min after T0. The N₂O concentration was measured by using capillary gas chromatography coupled with mass spectrometry. Percentages of N₂O in the CO₂ increased with time (t) according to the ideal equation: N₂O_(t) = 66 (1 - exp^-0.005t). In the peritoneal cavity, <2 h were required for the N₂O to reach the concentration of 29%, which can support combustion. Eight hours to 10 h after T0, the intraperitoneal N₂O fraction approaches the level of the N₂O end-tidal fraction. Options to prevent accumulation of N₂O are suggested.

Implications: Pig models were used to evaluate the time course of nitrous oxide (N₂O) diffusion in the pneumoperitoneum during nitrous oxide/oxygen anesthesia. Although peritoneal N₂O concentration approaches the end-expiratory value after 8–10 h, it reaches 29% within 2 h. At this level, N₂O is known to support combustion. This N₂O pollution should be prevented.

This article has been cited by other articles:

				P. A. Diemunsch, T. Van Dorsselaer, K. D. Torp, R. Schaeffer, and B. Geny Calibrated Pneumoperitoneal Venting to Prevent N2O Accumulation in the CO2 Pneumoperitoneum During Laparoscopy with Inhaled Anesthesia: An Experimental Study in Pigs Anesth. Analg., April 1, 2002; 94(4): 1014 - 1018. [Abstract] [Full Text] [PDF]

				C. S. Weenig, P. A. Diemunsch, S. Doumbia, and J. Leroy N2O Usage in Laparoscopic Cases Response Anesth. Analg., October 1, 2000; 91(5): 1306 - 1307. [Full Text] [PDF]