Warm, Humidified Carbon Dioxide Gas Insufflation for Laparoscopic Appendicectomy in Children A Double-Blinded Randomized Controlled Trial

Objective: To investigate clinical benefits of warm, humidified carbon dioxide (CO2) insufflation for acute laparoscopic appendicectomy on postoperative pain and recovery in children (age 8-14 years). Background: Conventional CO2 insufflation leads to desiccation-related peritoneal inflammation and injury, which is preventable with warm, humidified CO2 gas. We hypothesized that reduced peritoneal desiccation would improve patient-centered outcomes in children after laparoscopic appendicectomy. Method: A double-blinded, randomized controlled trial was conducted. Intervention group participants received warm (37 degrees C), humidified (98% relative humidity) CO2 gas insufflation, whereas control participants received standard room temperature (20 degrees C) gas with 0% relative humidity. Perioperative analgesia and anesthesia were standardized. Postoperative opiate usage was converted to morphine equivalent daily dosages (MEDD) for comparison, and pain intensity at rest and on moving was rated by participants using visual analog scales. Postoperative recovery and return to normal activities was assessed using a questionnaire on day 10. Results: Between February 2010 and March 2011, a total of 190 participants were randomized. Both intervention and control groups were matched at baseline. Postoperative MEDD and pain scores were also similar. There were no differences in postoperative recovery parameters. Conclusions: Warm, humidified CO2 insufflation for acute laparoscopic appendicectomy has no short-term clinical benefits on postoperative outcomes in pediatric patients (ClinicalTrials.gov trial identifying code: NCT01027455).