Double-blind, prospective, randomized study of warmed, humidifield carbon dioxide insufflation vs standard carbon dioxide for patients undergoing laparoscopic cholecystectomy

Hypothesis: Patients undergoing warmed, humidified carbon dioxide (CO ₂) insufflation for laparoscopic cholecystectomy will (1) maintain a warmer intraoperative core temperature, (2) have their surgeon experience less fogging of the camera lens, and (3) have less postoperative pain than patients undergoing laparoscopic cholecystectomy with standard Co₂ insufflation. Design: A double-blind, prospective, randomized study comparing patients undergoing laparoscopic cholecystectomy with standard CO₂ insufflation vs those receiving warmed, humidified CO₂ (Insuflow Filter Heater Hydrator; Lexion Medical, St Paul, Minn) was performed. Main variables included patient core temperature, postoperative pain, analgesic requirements, and camera lens fogging. Results: One hundred one blinded patients (69 women, 32 men) undergoing laparoscopic cholecystectomy were randomized into 2 groups-52 receiving standard CO₂ insufflation (group A) and 49 receiving warmed, humidified CO₂ (group B). Mean patient intraoperative core temperature change (group A decreased by 0.03°C, group B increased by 0.29°C, P=.01) and mean abdominal pain (Likert scale, 0-10) at 14 days postoperatively (group A, 1.0; group B, 0.3; P=.02) were different, Other variables (camera lens fogging, early postoperative pain, narcotic requirements, recovery room stay, and return to normal activities) between groups were similar. Conclusion: While patients undergoing laparoscopic cholecystectomy with warmed, humidified CO₂ had several advantages that were statistically significant, no major clinically relevant differences between groups A and B were evident.