Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model

    Research output: Contribution to journalArticle

    156 Citations (Scopus)

    Abstract

    The objective of this study was to evaluate the physiologic consequences of a pneumoperitoneum (pneumo) to the midterm fetus in a pregnant sheep model. The performance of laparoscopic cholecystectomy (LC) during pregnancy is controversial. The primary concern regarding the safety of LC during pregnancy is the physiologic consequences of the CO2 pneumo to the fetus. Eight ewes with singlet pregnancies between 100 and 120 days of gestation were anesthetized and intubated. Carotid artery and internal jugular catheters were placed in the ewe and in the fetus. Two trocars were placed through the abdominal wall of the ewe and the abdomen was inflated with CO2 or N2O at 15 mmHg pressure for 90-120 min. Hemodynamic and blood gas data were obtained every 15 min before, during, and after the pneumo. In two ewes attempts were made to keep maternal Pco2 constant with hyperventilation. In two other animals the pneumo was increased stepwise in five mmHg increments to 25 mmHg. One fetus succumbed during the CO2 pneumo, but this animal appeared to be ill during the establishment of invasive monitoring. Fetal respiratory acidosis occurred, reproducibly, after establishment of CO2 pneumo but did not occur before insufflation or under N2O pneumo (P2 pneumo than during N2O pneumo. Alterations in ventilator settings based on maternal capnography resulted in late and incomplete correction of respiratory acidosis. Despite clinical reports of successful LC during pregnancy, significant respiratory acidosis may be induced in the fetus with CO2 pneumo. Alternative gases (e.g., N2O) or abdominal suspension devices may be preferable to CO2 when performing laparoscopy in pregnant patients.

    Original languageEnglish (US)
    Pages (from-to)272-279
    Number of pages8
    JournalSurgical Endoscopy and Other Interventional Techniques
    Volume9
    Issue number3
    DOIs
    StatePublished - Mar 1995

    Fingerprint

    Pneumoperitoneum
    Acidosis
    Carbon Dioxide
    Respiratory Acidosis
    Fetus
    Laparoscopic Cholecystectomy
    Pregnancy
    Gases
    Mothers
    Capnography
    Insufflation
    Hyperventilation
    Internal Carotid Artery
    Abdominal Wall
    Mechanical Ventilators
    Surgical Instruments
    Abdomen
    Laparoscopy
    Sheep
    Suspensions

    Keywords

    • Carbon dioxide
    • Fetal acidosis
    • Model
    • Pregnant ewe

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. / Hunter, John; Swanstrom, L.; Thornburg, Kent.

    In: Surgical Endoscopy and Other Interventional Techniques, Vol. 9, No. 3, 03.1995, p. 272-279.

    Research output: Contribution to journalArticle

    @article{d5d6312ecbfb4ba69e30aad56e0fc173,
    title = "Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model",
    abstract = "The objective of this study was to evaluate the physiologic consequences of a pneumoperitoneum (pneumo) to the midterm fetus in a pregnant sheep model. The performance of laparoscopic cholecystectomy (LC) during pregnancy is controversial. The primary concern regarding the safety of LC during pregnancy is the physiologic consequences of the CO2 pneumo to the fetus. Eight ewes with singlet pregnancies between 100 and 120 days of gestation were anesthetized and intubated. Carotid artery and internal jugular catheters were placed in the ewe and in the fetus. Two trocars were placed through the abdominal wall of the ewe and the abdomen was inflated with CO2 or N2O at 15 mmHg pressure for 90-120 min. Hemodynamic and blood gas data were obtained every 15 min before, during, and after the pneumo. In two ewes attempts were made to keep maternal Pco2 constant with hyperventilation. In two other animals the pneumo was increased stepwise in five mmHg increments to 25 mmHg. One fetus succumbed during the CO2 pneumo, but this animal appeared to be ill during the establishment of invasive monitoring. Fetal respiratory acidosis occurred, reproducibly, after establishment of CO2 pneumo but did not occur before insufflation or under N2O pneumo (P2 pneumo than during N2O pneumo. Alterations in ventilator settings based on maternal capnography resulted in late and incomplete correction of respiratory acidosis. Despite clinical reports of successful LC during pregnancy, significant respiratory acidosis may be induced in the fetus with CO2 pneumo. Alternative gases (e.g., N2O) or abdominal suspension devices may be preferable to CO2 when performing laparoscopy in pregnant patients.",
    keywords = "Carbon dioxide, Fetal acidosis, Model, Pregnant ewe",
    author = "John Hunter and L. Swanstrom and Kent Thornburg",
    year = "1995",
    month = "3",
    doi = "10.1007/BF00187767",
    language = "English (US)",
    volume = "9",
    pages = "272--279",
    journal = "Surgical Endoscopy and Other Interventional Techniques",
    issn = "0930-2794",
    publisher = "Springer New York",
    number = "3",

    }

    TY - JOUR

    T1 - Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model

    AU - Hunter, John

    AU - Swanstrom, L.

    AU - Thornburg, Kent

    PY - 1995/3

    Y1 - 1995/3

    N2 - The objective of this study was to evaluate the physiologic consequences of a pneumoperitoneum (pneumo) to the midterm fetus in a pregnant sheep model. The performance of laparoscopic cholecystectomy (LC) during pregnancy is controversial. The primary concern regarding the safety of LC during pregnancy is the physiologic consequences of the CO2 pneumo to the fetus. Eight ewes with singlet pregnancies between 100 and 120 days of gestation were anesthetized and intubated. Carotid artery and internal jugular catheters were placed in the ewe and in the fetus. Two trocars were placed through the abdominal wall of the ewe and the abdomen was inflated with CO2 or N2O at 15 mmHg pressure for 90-120 min. Hemodynamic and blood gas data were obtained every 15 min before, during, and after the pneumo. In two ewes attempts were made to keep maternal Pco2 constant with hyperventilation. In two other animals the pneumo was increased stepwise in five mmHg increments to 25 mmHg. One fetus succumbed during the CO2 pneumo, but this animal appeared to be ill during the establishment of invasive monitoring. Fetal respiratory acidosis occurred, reproducibly, after establishment of CO2 pneumo but did not occur before insufflation or under N2O pneumo (P2 pneumo than during N2O pneumo. Alterations in ventilator settings based on maternal capnography resulted in late and incomplete correction of respiratory acidosis. Despite clinical reports of successful LC during pregnancy, significant respiratory acidosis may be induced in the fetus with CO2 pneumo. Alternative gases (e.g., N2O) or abdominal suspension devices may be preferable to CO2 when performing laparoscopy in pregnant patients.

    AB - The objective of this study was to evaluate the physiologic consequences of a pneumoperitoneum (pneumo) to the midterm fetus in a pregnant sheep model. The performance of laparoscopic cholecystectomy (LC) during pregnancy is controversial. The primary concern regarding the safety of LC during pregnancy is the physiologic consequences of the CO2 pneumo to the fetus. Eight ewes with singlet pregnancies between 100 and 120 days of gestation were anesthetized and intubated. Carotid artery and internal jugular catheters were placed in the ewe and in the fetus. Two trocars were placed through the abdominal wall of the ewe and the abdomen was inflated with CO2 or N2O at 15 mmHg pressure for 90-120 min. Hemodynamic and blood gas data were obtained every 15 min before, during, and after the pneumo. In two ewes attempts were made to keep maternal Pco2 constant with hyperventilation. In two other animals the pneumo was increased stepwise in five mmHg increments to 25 mmHg. One fetus succumbed during the CO2 pneumo, but this animal appeared to be ill during the establishment of invasive monitoring. Fetal respiratory acidosis occurred, reproducibly, after establishment of CO2 pneumo but did not occur before insufflation or under N2O pneumo (P2 pneumo than during N2O pneumo. Alterations in ventilator settings based on maternal capnography resulted in late and incomplete correction of respiratory acidosis. Despite clinical reports of successful LC during pregnancy, significant respiratory acidosis may be induced in the fetus with CO2 pneumo. Alternative gases (e.g., N2O) or abdominal suspension devices may be preferable to CO2 when performing laparoscopy in pregnant patients.

    KW - Carbon dioxide

    KW - Fetal acidosis

    KW - Model

    KW - Pregnant ewe

    UR - http://www.scopus.com/inward/record.url?scp=0029264859&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=0029264859&partnerID=8YFLogxK

    U2 - 10.1007/BF00187767

    DO - 10.1007/BF00187767

    M3 - Article

    C2 - 7597597

    AN - SCOPUS:0029264859

    VL - 9

    SP - 272

    EP - 279

    JO - Surgical Endoscopy and Other Interventional Techniques

    JF - Surgical Endoscopy and Other Interventional Techniques

    SN - 0930-2794

    IS - 3

    ER -