Gasinsufflation

Gasinsufflation, also known as gas insufflation, is the deliberate introduction of a gas into a body cavity to create or maintain a working space for medical procedures. The most commonly used gas is carbon dioxide (CO2) because of its high solubility in blood, rapid elimination by the lungs, and non-flammable nature. In some settings, ambient air or other gases have been used historically or in specialized contexts, but CO2 remains the standard.

In practice, gas insufflation serves two main purposes. During endoscopy, insufflation distends the gastrointestinal lumen to improve visualization and instrument passage. In laparoscopic surgery, CO2 is insufflated into the peritoneal cavity to form pneumoperitoneum, creating a space for visualization and manipulation of instruments. Typical intra-abdominal pressures during adult laparoscopy are about 12 to 15 mmHg, with adjustments for patient factors; flow rates commonly range from 0.5 to 2 L/min. Insufflation systems include a regulated gas source, delivery cannulas or trocars, and a pressure-monitoring device.

Gas choice and safety considerations are central to practice. CO2 is preferred because of rapid physiologic elimination and predictable behavior; other gases are rarely used due to safety concerns or suboptimal properties. Benefits of insufflation include improved visualization and instrument maneuverability, while risks include physiologic effects from increased intra-cavitary pressure and CO2 absorption, which can cause hypercapnia and acidosis. Rare complications comprise subcutaneous emphysema, pneumothorax, pneumomediastinum, gas embolism, and cardiopulmonary compromise, particularly in patients with significant comorbidities. Monitoring (e.g., capnography and hemodynamic assessment) and careful control of pressure and ventilation help mitigate these risks. In some procedures, alternatives such as gasless laparoscopic techniques or alternative access methods are explored to avoid or limit insufflation.