{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:46:53Z","timestamp":1791982013248,"version":"4.4.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"Abstract<\/jats:title>\n \n Introduction:<\/jats:title>\n \n Laparoscopic cholecystectomy (LC) uses carbon dioxide (CO\n 2<\/jats:sub>\n ) insufflation to create pneumoperitoneum, which can affect haemodynamic stability. This study compares the effects of fast versus slow CO\n 2<\/jats:sub>\n insufflation on haemodynamic parameters and post-operative pain in elective LC patients.\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods:<\/jats:title>\n \n An observational study was conducted on American Society of Anestheisology category 1\/2 patients undergoing elective LC from October 2023 to August 2024, consecutively assigned to Group A (slow insufflation, 2\u20134 L\/min) or Group B (fast insufflation, 8\u201310 L\/min). Intraoperative monitoring of mean arterial pressure (MAP), heart rate (HR) and end-tidal CO\n 2<\/jats:sub>\n was performed immediately after induction of anaesthesia. Post-operative pain was assessed using the Visual Analogue Scale, with the first reading recorded 4 hours after extubation, followed by two additional readings taken at 12-hour intervals thereafter.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Sixty-eight patients were analysed. Fast insufflation led to higher HRs at several time points and higher MAP at T4 and T5. Post-operative shoulder pain was more frequent with fast insufflation at 4 h (\n P<\/jats:italic>\n = 0.001) and 12 h after the 1\n st<\/jats:sup>\n reading (\n P<\/jats:italic>\n = 0.002). No significant complications were noted in either group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n Fast CO\n 2<\/jats:sub>\n insufflation resulted in higher HRs, MAPs at certain time intervals, increased post-operative shoulder pain and surgical site pain at 4 h, while other haemodynamic parameters and surgical site pain at two subsequent 12-h intervals were comparable.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jmas.jmas_356_24","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T18:00:18Z","timestamp":1775584818000},"page":"418-423","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of fast and slow CO2 insufflation on hemodynamic parameters in elective laparoscopic cholecystectomy"],"prefix":"10.4103","volume":"22","author":[{"given":"Raheef Pazhaya","family":"Pattillath","sequence":"first","affiliation":[{"name":"Department of Surgical Gastroenterology, Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiji S.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roby","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V R Anantha","family":"Krishna","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, Medical College, Thiruvananthapuram, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"R2-20261014","first-page":"CD009569","article-title":"Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery","volume":"3","author":"Yang","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"R4-20261014","doi-asserted-by":"crossref","first-page":"276","DOI":"10.4097\/kjae.2013.65.3.276","article-title":"Bradycardia during laparoscopic surgery due to high flow rate of CO2 insufflation","volume":"65","author":"Jung","year":"2013","journal-title":"Korean J Anesthesiol"},{"key":"R5-20261014","first-page":"e34071","article-title":"Comparison of different carbon dioxide insufflation rates on hemodynamic changes in laparoscopic surgeries: A randomized controlled trial","volume":"15","author":"Venkatraman","year":"2023","journal-title":"Cureus"},{"key":"R6-20261014","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1093\/bja\/70.6.681","article-title":"Haemodynamic changes in patients undergoing laparoscopic cholecystectomy: Measurement by transthoracic electrical bioimpedance","volume":"70","author":"Critchley","year":"1993","journal-title":"Br J Anaesth"},{"key":"R7-20261014","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1001\/archsurg.1992.01420080051008","article-title":"Laparoscopic cholecystectomy. The new \u2019gold standard\u2019?","volume":"127","author":"Soper","year":"1992","journal-title":"Arch Surg"},{"key":"R8-20261014","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/0011-3840(91)90041-M","article-title":"Laparoscopic cholecystectomy","volume":"28","author":"Soper","year":"1991","journal-title":"Curr Probl Surg"},{"key":"R9-20261014","doi-asserted-by":"crossref","first-page":"90","DOI":"10.23958\/ijirms\/vol01-i04\/01","article-title":"Study of the effect of the rate of flow of carbon dioxide gas for creation of pneumoperitoneum on cardiovascular system during laparoscopic surgeries","volume":"1","author":"Meshram","year":"2016","journal-title":"Int J Innov Res Med Sci"},{"key":"R10-20261014","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1161\/CIRCULATIONAHA.116.023262","article-title":"Cardiovascular and ventilatory consequences of laparoscopic surgery","volume":"135","author":"Atkinson","year":"2017","journal-title":"Circulation"},{"key":"R11-20261014","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.21037\/atm-21-3407","article-title":"Hemodynamic changes of anesthesia, pneumoperitoneum, and head-down tilt during laparoscopic surgery in elderly patients","volume":"9","author":"Jin","year":"2021","journal-title":"Ann Transl Med"},{"key":"R12-20261014","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1046\/j.1365-2168.2000.01507.x","article-title":"Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy","volume":"87","author":"Sarli","year":"2000","journal-title":"Br J Surg"},{"key":"R13-20261014","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.cmrp.2019.05.008","article-title":"Insufflation pressure and its effect on shoulder tip pain after laparoscopic cholecystectomy \u2013 A single-blinded, randomised study on 200 patients","volume":"9","author":"Pulle","year":"2019","journal-title":"Curr Med Res Pract"},{"key":"R14-20261014","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1213\/ane.0b013e3181b4874d","article-title":"An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy","volume":"109","author":"Chang","year":"2009","journal-title":"Anesth Analg"},{"key":"R15-20261014","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1381\/0960892055002149","article-title":"Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery","volume":"15","author":"Dixon","year":"2005","journal-title":"Obes Surg"},{"key":"R16-20261014","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1097\/AOG.0b013e31816e34b4","article-title":"A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: A randomized controlled trial","volume":"111","author":"Phelps","year":"2008","journal-title":"Obstet Gynecol"},{"key":"R17-20261014","doi-asserted-by":"crossref","first-page":"3","DOI":"10.7602\/jmis.2020.23.1.3","article-title":"Postoperative shoulder pain after laparoscopic surgery","volume":"23","author":"Park","year":"2020","journal-title":"J Minim Invasive Surg"},{"key":"R18-20261014","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4174\/jkss.2013.85.4.149","article-title":"Effect of laparoscopic cholecystectomy techniques on postoperative pain: A prospective randomized study","volume":"85","author":"Yilmaz","year":"2013","journal-title":"J Korean Surg Soc"},{"key":"R19-20261014","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s13104-023-06492-y","article-title":"Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: A randomized controlled clinical trial","volume":"16","author":"Rashdan","year":"2023","journal-title":"BMC Res Notes"}],"container-title":["Journal of Minimal Access Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.jmas_356_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:01:25Z","timestamp":1791979285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.jmas_356_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jmas.jmas_356_24","relation":{},"ISSN":["0972-9941","1998-3921"],"issn-type":[{"value":"0972-9941","type":"print"},{"value":"1998-3921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]},"assertion":[{"value":"2024-11-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-19","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}