Hypercapnia during transperitoneal and retroperitoneal endoscopic spinal surgery: A prospective study

Abstract Study objective To evaluate the effect of carbon dioxide (CO 2 ) pneumoperitoneum and retropneumoperitoneum insufflation on CO 2 excretion. Design Prospective study. Setting Operating room and recovery room in a teaching hospital. Patients 29 patients scheduled for orthopedic spine fusion surgery. Interventions Patients received either transperitoneal insufflation (n = 12) or retroperitoneal insufflation (n = 17). Measurements and main results: Increases in the partial pressure of end-tidal CO 2 (PetCO 2 ) and arterial CO 2 tension (PaCO 2 ) during retropneumoperitoneum exceeded those obtained during pneumoperitoneum. Furthermore, PetCO 2 increased faster during retroperitoneum and did not reach a plateau. Finally, 76% of the patients in this group required ventilatory adjustment due to high PetCO 2 levels. Conclusions This study may focus attention on the need for continuous ventilatory adjustments during transperitoneal endoscopic surgery.