Comparison of fast and slow CO2 insufflation on hemodynamic parameters in elective laparoscopic cholecystectomy

INTRODUCTION: Laparoscopic cholecystectomy (LC) uses carbon dioxide (CO2) insufflation to create pneumoperitoneum, which can affect haemodynamic stability. This study compares the effects of fast versus slow CO2 insufflation on haemodynamic parameters and post-operative pain in elective LC patients. PATIENTS AND METHODS: An observational study was conducted on American Society of Anestheisology category 1/2 patients undergoing elective LC from October 2023 to August 2024, consecutively assigned to Group A (slow insufflation, 2-4 L/min) or Group B (fast insufflation, 8-10 L/min). Intraoperative monitoring of mean arterial pressure (MAP), heart rate (HR) and end-tidal CO2 was performed immediately after induction of anaesthesia. Post-operative pain was assessed using the Visual Analogue Scale, with the first reading recorded 4 hours after extubation, followed by two additional readings taken at 12-hour intervals thereafter. RESULTS: Sixty-eight patients were analysed. Fast insufflation led to higher HRs at several time points and higher MAP at T4 and T5. Post-operative shoulder pain was more frequent with fast insufflation at 4 h (P = 0.001) and 12 h after the 1st reading (P = 0.002). No significant complications were noted in either group. CONCLUSION: Fast CO2 insufflation resulted in higher HRs, MAPs at certain time intervals, increased post-operative shoulder pain and surgical site pain at 4 h, while other haemodynamic parameters and surgical site pain at two subsequent 12-h intervals were comparable.