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RESEARCH ARTICLE
A Study on Effects of Leaking Carbon Dioxide Gas on

Surgeons during Laparoscopic Surgeries

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Mallikarjuna Manangi , Ranjitha Gangadharaiah , Santhosh S Chikkanayakanahalli , Madhuri G Naik , Arun Balagatte Jayappa 5
AbstrAct
Background: Laparoscopic surgery is gold standard for treating various abdominal diseases. Carbon dioxide, having high safety profile, is the
most commonly used gas for insufflating peritoneal cavity for accurate visualization and operative manipulation. Despite the fact that CO
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is naturally present in the atmosphere, i.e., 0.035% (350 ppm), it is one of the most overlooked toxic gases. CO breathing causes numerous
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cardiorespiratory responses and psychological reactions, such as impaired vision, diminished motor control, slowed responses, disorientation,
or reduced attentional capacities that may jeopardize a worker’s health and safety. At high concentrations (8%), it has been shown to cause
unconsciousness almost instantaneously and respiratory arrest within 1 minute. As laparoscopic surgeons are under constant exposure of leaking
CO gas, this study is taken up to evaluate the effects of CO on them by a noninvasive technique that measures end-tidal CO of operating
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surgeons at the beginning and end of laparoscopic surgeries.
Objective: To evaluate the effects of leaking CO gas on surgeons during laparoscopic surgeries.
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Methods: A Mini-Mental State Exam (MMSE) score and EtCO levels (using a capnometer with 4 L of oxygen/minute) of operating surgeons
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were obtained before the start of surgery. After surgery, MMSE scores and EtCO levels were again documented, compared, and analyzed using
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SPSS software.
Results: The mean EtCO before surgery was found to be 30.86 with standard deviation of 4.03 and that after surgery was 31.23 with standard
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deviation of 3.85 with mean duration of surgery being 73 minutes. Correlation of individual EtCO values before and after surgery did not show
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significant changes (p value = 0.534). The difference in MMSE scale scores before and after surgery for all participated surgeons was insignificant.
Conclusion: In healthy surgeons performing laparoscopic surgeries, there are no effects following exposure to leaking carbon dioxide.
Keywords: Air quality, Carbon dioxide, CO , EtCO , Laparoscopic surgeries, Laparoscopy, Leaking CO .
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World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1446
IntroductIon 1,3,4 Department of General Surgery, Bangalore Medical College and
Laparoscopic surgery has established itself as a gold standard for Research Institute, Bengaluru, Karnataka, India
treating various abdominal diseases in the recent decades, with 2 Department of Anaesthesiology, Bangalore Medical College and
benefits including but not limited to improved cosmesis, reduced Research Institute, Bengaluru, Karnataka, India
surgical trauma and postoperative pain, and expedited patient recovery 5 Department of Pulmonology, Bangalore Medical College and
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times. Carbon dioxide (CO ), because of its high safety profile, is the Research Institute, Bengaluru, Karnataka, India
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most commonly used gas for insufflating the peritoneal cavity for Corresponding Author: Madhuri G Naik, Department of General Surgery,
accurate visualization and operative manipulation. Despite the fact Bangalore Medical College and Research Institute, Bengaluru, Karnataka,
that CO is naturally present in the atmosphere, i.e., 0.035% (350 ppm) India, Phone: +91 08123639816, e-mail: naikmadhurig@gmail.com
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and we exhale it while breathing, CO is one of the most overlooked How to cite this article: Manangi M, Gangadharaiah R,
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toxic gases. CO is heavier than air with a density of 1.5 times that of Chikkanayakanahalli SS, et al. A Study on Effects of Leaking Carbon
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fresh air. When it is released into an enclosed space, it tends to settle Dioxide Gas on Surgeons during Laparoscopic Surgeries. World J Lap
to the bottom, reaching the highest concentration in the lowest parts Surg 2021;14(2):103–105.
of space. Carbon dioxide breathing causes numerous cardiorespiratory Source of support: Nil

responses, but there appear to be no disabling physiological effects Conflict of interest: None
or clinical symptoms associated with breathing up to 5% CO . 2–4
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Nonetheless, there still may be psychological reactions, such as impaired
vision, diminished motor control, slowed reactions and responses, • Direct stimulation of the vasomotor centers in the hypothalamus,
disorientation, or reduced attentional capacities that may jeopardize a midbrain, and medulla.
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worker’s health and safety. The physiological effects of carbon dioxide • Direct action on the cerebral blood vessels.
on the central nervous system have been roughly classified. They are • Effect on the affinity of blood for oxygen. 7
both direct and indirect in their mechanism of stimulation.
The most important control of cerebral blood flow is chemical.
• Direct stimulation of the respiratory centers in the medulla and The cerebral vascular bed is extremely sensitive to changes in arterial
spinal cord. CO tension and also to a lesser extent to decrease in O tension. 8
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• Stimulation of the special nerve endings (chemoreceptors) in US Occupational Safety and Health Administration (OSHA) has
the carotid bodies and aortic arch, with the resultant vasodilator established a permissible exposure limit (PEL) for carbon dioxide of
action on the cerebral blood vessels. 5000 ppm (0.5%) averaged over an 8-hour workday.
© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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