Carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography under general anesthesia

Aim. The aim of this paper was to evaluate the effect of carbon dioxide (CO(2)) vs. air insufflation on post-endoscopic retrograde cholangiopancreatography (ERCP) abdominal pain and distension. In addition, we investigated the changes in the partial pressure of endtidal CO(2) (PetCO(2)) and the partial pressure of arterial CO(2) (PaCO(2)). Methods. From October 2009 to January 2010, all patients admitted to our centre for ERCP were screened for enrollment; the patients recruited were randomised to CO(2) or air insufflation. The patients were asked to rate their abdominal pain intensity and distension using a 100-mm Visual Analogue Scale (VAS) before, in the recovery room and at 1, 3, 6 and 24 hours after the ERCP. All anesthesiological and endoscopic details and complications were evaluated. Results. We included 76 patients, 39 in the Air group and 37 in the CO(2) group. The groups were similar for age, gender, indications and duration of the procedure. Post-procedure mean values of pain (in the recovery room and at 1,3 and 6 hours) and distension (at recovery room, and at 1 and 3 hours) according to the VAS were significantly reduced in the CO(2) group as compared to the Air group. At baseline, the PetCO(2) values were similar between the two groups while, during the ERCP, they increased significantly in CO(2) group as compared to the Air group; these values were reduced by simply increasing the ventilation. Conclusion. CO(2) insufflation during ERCP significantly reduces post-procedural abdominal pain and distension. Increased PetCO(2) and PaCO(2) values remained within acceptable or readily controllable ranges.