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CO₂ insufflation consequences on respiratory and cardiovascular parameters in laparoscopic cholecystectomy patients: a prospective observational cohort

Shireen Mahmood Noori
Department of Anesthesia Sciences, Erbil Medical Technical Institute, Erbil, Kurdistan Region, Iraq
Haidar Nasser Mohammed
Department of Anesthesia Sciences, Anesthesia and Intensive Care Medicine, College of Health Sciences, University of Duhok, Kurdistan Region, Iraq
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Copyright (c) 2026 Shireen Mahmood Noori, Haidar Nasser Mohammed (Author)

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Abstract

Background and objective: Pneumoperitoneum is essential to provide a good surgical view during laparoscopy. Carbon dioxide is the most commonly used gas for pneumoperitoneum, and it induces multiple changes in the mechanics of respiration and cardiovascular function, particularly under general anesthesia. This study aimed to identify the key physiological parameters most likely to deviate from normal during laparoscopic cholecystectomy. Respiratory variables assessed included end-tidal CO₂ (EtCO₂) and peak airway pressure, while cardiovascular parameters encompassed mean blood pressure (MBP), pulse rate, body temperature, and oxygen saturation.

Methods: This prospective observational cohort study evaluated physiological changes in patients classified as American Society of Anesthesiologists (ASA) grade I/II undergoing elective laparoscopic cholecystectomy at Rizgary Teaching Hospital, Iraq, over four months. A sample of 186 patients, aged 18–75 years, meeting inclusion and exclusion criteria were enrolled. Median-split methodology was used to divide patients into two groups based on the median duration of surgery (≤27 minutes vs. >27 minutes).

Results: CO₂ insufflation during laparoscopic surgery led to significant physiological changes. Mean blood pressure decreased from 95.7±13.5 mmHg to 87.4±14.3 mmHg (p <0.001), and heart rate dropped from 95.6±16.2 bpm to 89.3±13.8 bpm (p <0.001). Peak inspiratory pressure (PIP) increased markedly from 15.9±3.7 cmH₂O to 21.2±3.8 cmH₂O (p <0.001), while end-tidal CO₂ declined from 33.7±4.1 mmHg to 31.2±4.9 mmHg (p <0.001). Following CO₂ exsufflation, PIP decreased to 18.7±8.0 cmH₂O, and end-tidal CO₂ increased to 37.5±6.1 mmHg (both p <0.001), reflecting improved respiratory compliance. Intraoperative comparisons revealed higher end-tidal CO₂ levels in procedures lasting more than 27 minutes compared with shorter ones: 32.6±4.8 mmHg vs. 29.8±4.6 mmHg after insufflation, 37.6±5.7 mmHg vs. 33.0±5.4 mmHg after artery clamping, and 39.2±6.0 mmHg vs. 34.5±5.8 mmHg after gallbladder dissection (all p <0.001). These findings emphasize the need for vigilant monitoring and ventilatory adjustments to prevent potential complications associated with CO₂ insufflation.

Conclusion: CO₂ insufflation caused notable fluctuation in most monitored parameters (end-tidal CO₂, peak inspiratory pressure, heart rate, body temperature). Minimizing insufflation time is a key factor in reducing pneumoperitoneum effects.

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How to Cite
Mahmood Noori, S., & Nasser Mohammed, H. . (2026). CO₂ insufflation consequences on respiratory and cardiovascular parameters in laparoscopic cholecystectomy patients: a prospective observational cohort. Zanco Journal of Medical Sciences (ZJMS), 758–767. https://doi.org/10.15218/zjms.2026.054

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