OBJECTIVE: To assess the efficacy and safety of Insuflow (Georgia BioMedical, Inc.) filter heater hydrator device in reducing the incidence, severity and extent of hypothermia, length of recovery room stay and postoperative pain at the time of laparoscopy. DESIGN: Prospective, randomized, blinded, controlled multi-center study. Patients underwent gynecologic procedures via laparoscopy; surgeons, anesthesiologists and recovery room personnel assessed the results. SETTING: Seven North American institutions. PATIENTS: Seventy-two women for safety evaluation and efficacy studies. INTERVENTIONS: Intraoperative pre-conditioning of laparoscopic gas with the Insuflow device (treatment) or standard raw gas (control) during laparoscopic surgery and postoperatively. MAIN OUTCOME MEASURES: Incidence, severity and extent of hypothermia, postoperative pain perception and length of recovery room stay. RESULTS: The Insuflow group had significantly less intraoperative hypothermia, reduced length of recovery room stay and reduced postoperative pain. Pre-conditioning of laparoscopic gas by filtering heating and hydrating was well tolerated with no adverse effects. The safety profile of the Insuflow pre-conditioned gas showed significant benefits compared to currently used raw gas. CONCLUSIONS: Pre-conditioning laparoscopic gas by filtering heating and hydrating with the Insuflow device was significantly more effective than the currently used standard raw gas and was safe in reducing or eliminating laparoscopic-induced hypothermia, shortening recovery room length of stay and reducing postoperative pain.

Adolescent↗

PubMedDate not supplied

Severe local hypothermia from laparoscopic gas evaporative jet cooling: a mechanism to explain clinical observations.

BACKGROUND AND OBJECTIVES: Explanations for laparoscopic-induced hypothermia fail to explain clinical observations. It is possible that water evaporation occurs from the jet stream of gas inflation resulting in tissue surface super-cooling leading to tissue damage and drying. METHODS: Theoretical calculations based on thermal conductivity, mass transfer effects and heat flux considerations correlated closely with synthetic and tissue experiments. Thermocouple measurements at a rate of 15 data points per second were performed. RESULTS: Cooling rates of 10 to 25 degrees centigrade per second for high flow rates were found based on gas flow rate and effective size of gas delivery site. These rapid temperature drops extended beyond a 2 cm2 diameter. CONCLUSIONS: Evaporative cooling accounts for significant hypothermia. The cooling is dependent on the lack of water vapor in the gases currently used during laparoscopy. Cooling rates are independent of height from tissue and geometry of delivery port. Heating and hydrating the gas to a physiologic condition eliminates hypothermia and tissue dessication.

Culture Techniques↗

PubMedDate not supplied

Microbial colonization of laparoscopic gas delivery systems: a qualitative analysis.

OBJECTIVE: Laparoscopic procedures utilize a pneumoperitoneum to distend and separate the abdominal wall from the intra-abdominal structures. Carbon dioxide is commonly used for this purpose, although this study is inclusive of any gas used for abdominal distention. The gas is delivered from cylinders through a gas insufflation delivery system. The purpose of this study is to determine if laparoscopic gas delivery systems composed of gas cylinders and insufflators used for laparoscopy have microbes present. METHODS: Gas delivery systems were evaluated for the presence of microbial growth using standard techniques. External connection sites, gas cylinders and the internal conduit tubing of insufflators were cultured. Fifty two (52) insufflators and sixty (60) gas cylinders were evaluated. RESULTS: Twelve (12) of the sixty cylinders (20%) and fifty four (54) of the sixty insufflators (92.3%) were culture positive. The organisms identified are significant and a varied spectrum. CONCLUSIONS: Recognition that gas cylinders, insufflation attachments and internal components of insufflators quantitatively contain microbes is demonstrated. Reduction of microbial exposure from insufflation apparatus is achieved by cleansing external ports and use of a 0.3 micron filter for abdominal pneumoperitoneum.

Carbon Dioxide↗