What is a notable risk when using Nitric Oxide as an insufflation gas?

• A. Fire hazard with electrocautery
• B. Increased risk of infection
• C. Hypercarbia-induced acidosis
• D. It cannot be used in patients with severe cardiopulmonary disease

Answer: (A)

The main concept here is that using an oxidizing gas inside the abdomen creates a real fire hazard when electrocautery is used. Nitric oxide can sustain combustion in an oxygen-rich environment, and the heat or sparks from electrocautery can ignite the gas–tissue mixture within the pneumoperitoneum. This makes intra-abdominal fires a dangerous possibility, which is why nitric oxide as an insufflation gas is avoided despite other gases. The other risks listed don’t reflect a direct, specific danger of using this gas: infection risk isn’t inherently increased by NO pneumoperitoneum, hypercarbia comes from CO2 exposure rather than NO, and while cardiopulmonary status matters in any case, the standout risk with this gas is the potential for burning in the presence of cautery.