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N2O and Laparoscopic Surgery
Started by drlee
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some studies show it doesn't really appreciably distend the bowel. some studies show it does. i think if it does distend the bowel it takes a couple of hours, at least to see a difference. i don't think there is any reason to use it for lap cases.
It's probably OK to use it if the case is not too long but why would you want to do that?
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Why not? 🙂
I use it most of the time unless the surgeon specifically requests not to have it. I don't buy the inflatable bowel concept. That bowel looks exactly the same when they first go in the belly as it does a couple hours later (or usually less than that) when they come out. If it was that big a deal, abdomens would never be able to be closed.
Let me see if I have this right. You want to administer an oxidizing gas (supports and accelerates combustion) which readily diffuses into air filled cavities to a person who has an artificially created air filled cavity in which it is likely that electrocautery will be in use?
There is a reason we insufflate with CO2.
I am not certain whether or not you could actually displace enough CO2 in the peritoneal cavity to support combustion, but I can imagine situations in which you might. More likely would be getting a large pocket of nitrous enriched bowel gas that would make a real mess of things should the cautery inadvertently penetrate the bowel.
Nitrous oxide decomposes exothermally under high temperature (649 C/ 1200 F) without the presence of a catalyst, and the decomposition can be self sustaining. Within specific temperatue and pressure conditions an explosive decomposition can occur.
Not saying it is likely, but it is certainly worth thinking about since nitrous gives such minimal benefit. If it does happen, give me a call so I can come and get my PhD in LMFAO.
- pod
There is a reason we insufflate with CO2.
I am not certain whether or not you could actually displace enough CO2 in the peritoneal cavity to support combustion, but I can imagine situations in which you might. More likely would be getting a large pocket of nitrous enriched bowel gas that would make a real mess of things should the cautery inadvertently penetrate the bowel.
Nitrous oxide decomposes exothermally under high temperature (649 C/ 1200 F) without the presence of a catalyst, and the decomposition can be self sustaining. Within specific temperatue and pressure conditions an explosive decomposition can occur.
Not saying it is likely, but it is certainly worth thinking about since nitrous gives such minimal benefit. If it does happen, give me a call so I can come and get my PhD in LMFAO.
- pod
What's N2O?
Nice
U funny
It's something us old farts use every day along with succinylcholine and that gas in the green tank. 😉
If they aren't tolerating gas very well, maybe? A lot of my nitrous use is for ACEI patients, when their BP drops if they get much agent on board, especially if it's not a very stimulating procedure.
I've worked with some upper-level residents at my place who choose to just run those cases light on 100% oxygen, and they seem to turn out just fine. I'm just not quite confident enough to start testing that boundary on a paralyzed patient.
