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Effect of Leaking CO on Operating Laparoscopic Surgeons
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Symptoms of Different Levels of Carbon Dioxide • Surgeries spanning less than 1 hour.
Exposure • Chronic smokers.
• 10000 ppm (1.0%): Typically no effects, possible drowsiness. • Hematological disorders.
• 15000 ppm (1.5%): Mild respiratory stimulation for some people. Source of data: Clinical data are collected from the surgeons
• 30000 ppm (3.0%): Moderate respiratory stimulation, increased performing laparoscopic procedures in Victoria hospitals from
heart rate, and blood pressure. August 2018 to September 2018.
• 50000 ppm (5.0%): Strong respiratory stimulation, dizziness,
confusion, headache, and shortness of breath. Methodology
• 80000 ppm (8%): Dimmed sight, sweating, tremor, Ten surgeons performing laparoscopic surgeries for more than
unconsciousness, and possible death. 9 1 hour in departments of general surgery in Victoria hospitals
Since the likelihood of laparoscopic surgeons getting exposed from August 2018 to September 2018 willing to give consent and
to CO gas due to leaky or faulty instruments or even during normal meeting the inclusion criteria were included in the study after the
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circumstances cannot be ruled out, this study is taken up to evaluate clearance by ethical committee. A Mini-Mental State Exam (MMSE)
the effects of leaking CO on them. score and EtCO levels (using a side-stream capnometer with 4 L
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End-tidal CO (EtCO ) monitoring is a noninvasive technique of oxygen/minute) of operating surgeons were recorded just
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that measures the partial pressure or maximal concentration of before the beginning and immediately after the completion of the
carbon dioxide at the end of an exhaled breath, which is expressed surgery. The data were recorded, compared, and analyzed using
as a percentage of CO or mm Hg. The normal values are 5 to 6% SPSS software version 24. Surgeons were enquired for symptoms
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CO in exhaled breath, which is equivalent to 35 to 45 mm Hg. such as dizziness, confusion, headache, shortness of breath, and
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When CO diffuses out of the lungs into the exhaled air, a device visual disturbances.
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called capnometer measures the partial pressure or maximal
concentration of CO at the end of exhalation. results
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Capnometry is a measurement of end-tidal CO partial
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pressure (PEtCO ). PEtCO closely approximates PaCO at the end The mean EtCO before surgery was found to be 30.86 with
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of normal expiration in conditions with normal perfusion and standard deviation of 4.03 and that after surgery was 31.23
ventilation and therefore makes the difference between PaCO and with standard deviation of 3.85. Mean duration of laparoscopic
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PEtCO minimal. In healthy individuals, there is essentially no surgeries was 73 minutes. Correlation of individual EtCO values
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alveolar dead space, which represents the volume of gases in before and after surgery did not show significant changes
non‐perfused alveoli. This means that PEtCO equals PaCO , and (p value = 0.534). The difference in MMSE scale scores before and
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with correct sampling, P(a–a)CO difference equals P(a–et) after surgery for all participated surgeons was insignificant. No
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CO difference, which makes PEtCO a good estimate of PaCO 2. 10 effects were noted on decision-making, steadiness, and postural
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sway. The operating surgeons did not have any complaints in the
postoperative period.
objectIve of the study
To evaluate the effects of leaking CO gas on surgeons during dIscussIon
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laparoscopic surgeries.
Carbon dioxide (CO ) is the product of cellular aerobic metabolism.
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MAterIAls And Methods It diffuses easily from cells into blood and erythrocytes and is
transported to the lungs by venous blood through the function
Type of the study: Prospective cohort study of cardiac output. Under normal conditions of circulation and
Time period: August 2018 to September 2018 ventilation, the partial pressure of CO approaches 50 mm Hg at the
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Sample size: Based on pilot study, the difference in EtCO was about level of tissues, and 45 mm Hg in the venous blood. The difference
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3 to 4 mm Hg. between the latter and alveolar CO partial pressure (PaCO ), which
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Assuming a 10% difference in EtCO before and after surgery is around 40 mm Hg, is responsible for the diffusion of CO into
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with a power of 80% and alpha error of 0.05, a sample size of 10 the alveoli. There, CO is eliminated from the body with minute
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was required. For further validation of the study and assuming ventilation. Arterial CO partial pressure (PaCO ) normally varies
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a dropout rate of 10%, a total sample size of 20 was taken. from 35 to 45 mm Hg. 10
Carbon dioxide is a colorless, odorless, and nonflammable gas,
Inclusion Criteria which because of its high safety profile is widely used to insufflate
• Surgeons and surgical residents willing to give written informed peritoneal cavities during laparoscopic surgeries. Being a highly
consent. soluble gas, it gets dissolved in blood soon after it is inhaled. It then
• Surgeons and surgical residents of either sex aged 25 to 65 years. binds to hemoglobin, and carboxyhemoglobin is formed, lowering
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• Surgeons and surgical residents performing laparoscopic hemoglobin’s affinity for oxygen via Bohr’s effect. Carbon dioxide
procedures for more than 1 hour. does not only cause asphyxiation by hypoxia but also acts as a
toxicant. At high concentrations (8%), it has been shown to cause
Exclusion Criteria unconsciousness almost instantaneously and respiratory arrest
• Not willing to participate in the study. within 1 minute. 12
• Age <25 years and age >65 years. Thus, during laparoscopic surgeries following exposure to
• Preexisting pulmonary conditions. leaking carbon dioxide, CO can be readily absorbed into the
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• Pregnancy. bloodstream and may result in significant hypercarbia.
104 World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021)