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The Effect Of Humidified And Heated Carbon Dioxide During Laparoscopic Surgury On Post Operative Pain And Incidence Of Hypothermia

3891 words - 16 pages

INTRODUCTIONThis assignment will review recent articles pertaining to the use of humidifiers for insufflation of Carbon Dioxide (CO2) in conjunction with laparoscopic surgery. It will discuss the results of the review in relation to clinical practice and will address how the information gained will be used to enhance patient care.Humidifiers are designed to humidify the CO2 to body temperature allowing the gas to be saturated with water vapour maintaining normal physiological conditions within the intra-abdominal cavity throughout the operation. The idea being that this reduces post operative pain, shortens recovery time and time to return to normal activities, and may lead to a reduction in the risk of other complications such as adhesions and hypothermia (Fisher and Paykel 2005).At present at MercyAscot where I am employed as a student PNSA humidified gas is not utilised in laparoscopic procedures. The aim of this literature review is to ascertain if humidifiers are beneficial to patient outcome, and should they be implemented at MercyAscot.CLINICAL OVERVIEWDuring laparoscopic surgery cold dry CO2 gas continuously flows into the abdominal cavity creating a pneumoperitoneum allowing a space for surgery to be performed. CO2 is used as it does not support combustion, is cost effective and it is soluble (Fisher and Paykel 2005).The peritoneum is an organ with unique properties, not designed to cope with variable conditions such as the introduction of cold dry gas. Due to this any change in the environment will have an impact, the larger the deviation from the normal intraabdominal conditions, the larger the effect. Thus the nature of the gas (cold and dry) and the extent of the exposure to this can be a factor in causing tissue damage (Fisher and Paykel 2005).Insufflation using CO2 during laparoscopic surgery has the same exposure effect as open surgery (Berber et al 2001). This is partly because laparoscopic gas is cooler than the operating air and much dryer as gas needs to be bone dry for storage in cylinders. Mild hypothermia is associated with laparoscopic surgery, and can causes complications such as wound infection, depressed respirations, decreased production of antibodies and depleted clotting factors (Macfayden 1999 Beilin et al 1998).The main causes of pain postoperatively are desiccation of tissue, adhesion formation, the surgical incision and referred shoulder tip pain (Polymeneas 2001). The surgical incision pain is not in contention within this literature review, as humidified CO2 has no impact on it. Shoulder tip pain is caused by the phrenic nerve being irritated by the effect of pneumoperitoneum and is not mentioned in any of the studies I have reviewed.Adhesions are inflammatory bands that connect opposing serous surfaces. Where two surfaces touch there is a risk they will stick together, especially if the surfaces are dry or damaged (Ryan et al 1971). Adhesions are formed after laparoscopic and open surgery (Jorgensen, et al...

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