Re: JSLS 2005;9:463–465 Heated, Humidified CO2 Gas Is Unsatisfactory for Awake Laparoscopy

Appropriate conscious sedation is a critical component for successful awake laparoscopy. It is not surprising that the patients in both cases experienced pain during laparoscopy, since only 50 g of fentanyl citrate was administered in the first case, and 100 g in the second case. The protocol used for conscious sedation must be of sufficient efficacy to allow the awake procedure to continue with little or no patient discomfort. I would recommend my protocol for conscious sedation with the adjunct of heated and humidified CO2 for the successful performance of awake laparoscopy. The fact that Dr Crabtree’s second patient experienced pain following insufflation with only 200 mL of CO2 suggests that his methodology needs to be refined.