Carbon dioxide and helium insufflation during laparoscopic radical nephrectomy in a patient with severe pulmonary disease

Carbon dioxide pneumoperitoneum produces variable degrees of hypercapnia. Excessive hypercapnia may result in cardiovascular depression and even cardiac arrest. We report on a woman with marked chronic obstructive pulmonary disease in whom significant hypercapnia and respiratory acidosis developed during laparoscopy with carbon dioxide insufflation, which was reversed when carbon dioxide was replaced with helium.