Measurement of CO2 hypothermia during laparoscopy and pelviscopy:: How cold it gets and how to prevent it

Study Objective. To evaluate intraabdominal CO2 temperature during a variety of standard operative laparoscopy procedures with different insufflators (BEI Medical, Snowden & Fencer, Storz Laparoflator, Storz Endoflator, Wolf) and devices to maintain body temperature (Bair Hugger, fluid warmer, Blanketrol blankets). Design. Prospective, nonrandomized study (Canadian Task Force classification II-1). Setting. Community hospital in rural Alabama. Patients. Sixty-two consecutive patients (53 women, 9 men; average age 56.8 yrs, range 21-94 yrs). Interventions. Patients underwent standard laparoscopic and pelviscopic procedures during which intraoperative temperature changes in the insufflation system, abdomen, and rectum were measured. Measurements and Main Results. Carbon dioxide was at room temperature in the insufflation hose (similar to 23 degrees C. During insufflation, intraabdominal gas temperature decreased to as much as 27.7 degrees C laverage 32.7 degrees C) depending on length of operation (23 min-5 hrs 8 min), amount of gas used (12.8-807 L) gas flow (up to 20 L/min), and leakage rate. Preoperative and postoperative temperature comparisons showed no decline in rectal temperature (average +0.18 degrees C) because warming equipment was sufficient. Conclusion. The decrease in intraoperative intraabdominal gas temperature is remarkable and can potentially harm the patient. It can be limited by restricting gas flow and leakage. In operations longer than I hour, substantial core body temperature drop should be prevented with appropriate heating and hydration devices. An insufflator with internal gas heating (Snowden & Fencer) had no significant clinical effect.