Carboxyhemoglobinemia due to peritoneal smoke absorption from laser tissue combustion at laparoscopy

OBJECTIVE: The carbon monoxide (CO) smoke component from tissue pyrolysis was evaluated for peritoneal absorption in patients undergoing laparoscopy to determine its effects and ability to be detected in peripheral blood. SUMMARY BACKGROUND DATA: Previous studies have demonstrated changes in peripheral methemoglobin levels as a result of peritoneal absorption of laser smoke. METHODS: Fifty patients had preoperative, intraoperative, and postoperative levels of carboxyhemoglobin (COHb) and pulse oximetry evaluated. The control group (25) had no laser or cautery used and the study group (25) had carbon dioxide laser used during the laparoscopic procedures. RESULTS: The control group showed no change in COHb, or intra-abdominal CO levels, before, during, and after the procedures, and no change in blood CO or pulse oximetry reading. The laser smoke group showed a statistically significantly elevated (p < .05) peripheral blood COHb levels, a significant increase in intra-abdominal CO concentration, and a lack of correlation of pulse oximetry and blood oxygen saturation experiments. CONCLUSIONS: CO is created in extremely large quantities during laser use at laparoscopy and is absorbed through the peritoneal cavity. Symptoms of smoke poisoning can be seen with these elevations. Continuous or intermittent removal of smoke produced from laser use is recommended.