Beneficial Effects of Humidified,Warmed Carbon Dioxide Insufflation during Laparoscopic Bariatric Surgery: a Randomized Clinical Trial

Background: Recent data has shown that the use of warmed, humidified carbon dioxide (CO₂) insufflation during laparoscopic surgery may be associated with better outcomes. Methods: We performed a randomized, doubleblind, prospective controlled clinical trial of 30 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP). Patients were randomized into 2 groups. The first group (group 1, n=15) received standard (dry, room temperature) CO₂ for insufflation during the surgery, while the second group (group 2, n=15) received warmed (35°C) and humidified (95%) CO₂. Patients received postoperative analgesia from morphine delivered via a patient-controlled analgesia (PCA) pump. Pain scores (on a scale of 0 to 10, 0 being no pain and 10 being the worst pain) were measured postoperatively at 3 h, 6 h, 1 day and 2 days. The amount of morphine that was delivered through the PCA was also measured at the same time intervals. Operating-room (OR) time, core temperature, and total hospital length of stay were documented. Results: Postoperative pain as documented by pain scores and narcotic usage were not statistically different in the 2 groups. We demonstrated a statistically significant difference (mean±SD) in OR time (76±16 min vs 101±34 min, P=0.02), total hospital length of stay (3.2±.4 days vs 4.0±.9 days, P=0.01) and end-of-case core temperature (36.2±.5°C vs 35.7±.6°C, P=0.02) in group 2 compared with group 1. Conclusion: The use of warmed, humidified CO₂ insufflation in bariatric patients undergoing LRYGBP was not associated with any significant benefit with regards to postoperative pain.