Effects of intraoperative insufflation with warmed, humidified CO2 during abdominal surgery: a review

Ju Yong Cheong*, Anil Keshava, Paul Witting, Christopher John Young

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
46 Downloads (Pure)


Purpose: During a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20°C, 0%–5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO2 in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes. Methods: A review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain. Results: The literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO2, cold, dry CO2 resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation. Seven of 15 human RCTs reported a significantly higher core body temperature in the warmed, humidified CO2 group than in the cold, dry CO2 group. Seven human RCTs found lower postoperative pain with the use of humidified, warmed CO2. Conclusion: While evidence supporting the benefits of using humidified and warmed CO2 can be found in the literature, a large human RCT is required to validate these findings.

Original languageEnglish
Pages (from-to)125-137
Number of pages13
JournalAnnals of Coloproctology
Issue number3
Publication statusPublished - 1 Jun 2018
Externally publishedYes

Bibliographical note

Copyright the Korean Society of Coloproctology 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • Carbon dioxide
  • Humidified
  • Intraperitoneal inflammation
  • Pneumoperitoneum
  • Surgical adhesions


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