To the Editor:—

Dr. Rosen 1provides a comprehensive review of anesthesia for the pregnant surgical patient, including some recommendations for the increasingly frequent procedure of laparoscopy during pregnancy. One of his recommendations is the use of nitrous oxide in place of carbon dioxide for establishing pneumoperitoneum.

This is a major departure from current clinical practice and deserves better supporting evidence than any provided in Dr. Rosen’s review. His sole reference regarding obstetric laparoscopy is a study of the Swedish Health Registry from 1973–1993, 2which compares complications of laparotomy with complications of laparoscopy. That article does not describe details of laparoscopic technique. However, one of the same authors 3published a 1997 survey of 16,329 laparoscopic surgeons that reported details of 413 laparoscopic cases during pregnancy, and 100% of those cases used carbon dioxide for pneumoperitoneum.

During pregnancy, special care should be taken to keep the intraabdominal pressure low (less than 15 mmHg) and maintain maternal normocapnia. Using these precautions, for several important reasons, including noncombustibility and easy, rapid elimination, carbon dioxide is the gas of choice for creating pneumoperitoneum.

Rosen MA: Management of anesthesia for the pregnant surgical patient. A nesthesiology 1999; 91:1159–63
Reedy MB, Kallen B, Kuehl TJ: Laparoscopy during pregnancy: A study of five fetal parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 1997; 177:673–9
Reedy MB, Galan HL, Richards WE, Preece CK, Wetter PA, Kuehl TJ: Laparoscopy during pregnancy. A survey of laparoendoscopic surgeons. J Reprod Med 1997; 42:33–8