Abstract
Purpose
The purpose of this study was to assess the effects of increased intra-abdominal pressure due to CO2 insufflation on the mechanical characteristics of the respiratory system and arterial blood gases during and after laparoscopic cholecystectomy.
Methods
Respiratory mechanics and arterial blood gases were examined in 12 patients undergoing laparoscopic cholecystectomy with CO2 insufflation. Respiratory mechanics were continuously monitored with in-line spirometry. In the recovery room, PaCO2 was measured in this group at 30 min and compared with PaCO2s in 23 patients who had undergone open cholecystectomy retrospectively, to evaluate the effects of insufflation on CO2 elimination.
Results
Minute ventilation was decreased by about 500 ml·min−1 during abdominal insufflation. Dynamic lung compliance decreased from 49.6 ± 4.7 to 30.7 ±2.3 (mean ± SEM) ml·cmH2O−1 with abdominal insufflation (P < 0.005), and returned to 45.1 ±3.1 after the release of pneumoperitoneum. Peak inspiratory pressure increased from 15.9 ± 0.9 to 18.9 ± 1.0 cmH2O with abdominal insufflation (P < 0.05). Arterial blood gas determinations indicated a decrease in arterial pH, with CO2 retention during insufflation and in the recovery room (P < 0.05). PaCO2 of the laparoscopic patients was higher than that of the open patients in the recovery room.
Conclusion
The results indicate that respiratory acidosis was caused during CO2 insufflation for laparoscopic cholecystectomy, that was due to (1) decreased compliance, (2) increased CO2 load and (3) insufficient ventilation. Accumulated CO2 during laparoscopic cholecystectomy increased PaCO2 level in the recovery room.
Résumé
Objectif
Evaluer les effets de l’augmentation de pression intraabdominale provoquée par l’insufflation de CO2 sur les caractéristiques du système respiratoire et des gaz du sang artériel pendant et après la cholécystectomie laparoscopique.
Méthode
La mécanique respiratoire et les gaz du sang artériels ont été étudiés chez 123 patients soumis à une cholé-cystectomie laparoscopique avec insufflation de CO2. La mécanique respiratore a été monitorée en continu par spirométrie. A la salle de réveil, la PaCO2 a été mésurée à la 30e min de l’admission et comparée rétrospectivement à la PaCO2 de 23 patients qui avaient subi une cholécystectomie ouverte, dans le but d’évaluer les effets de l’insufflation sur l’élimination du CO2.
Résultats
La ventilation minute a diminué d’environ 500 ml·min−1 pendant l’insufflation abdominale. La compliance dynamique pulmonaire diminuait de 49,6 ± 4,7 à 30,7 ± 2,3 (moyenne ± SEM) ml·cmH2O−1 avec l’insufflation (P < 0,005) et revenait à 45,1 ± 3,1 après le relâchement du pneumopéritoine. L’analyse des gaz artériels a révélé une diminution du pH artériel avec rétention de CO2 pendant l’insufflation et à la salle de réveil (P < 0,005). La PaCO2 des patients opérés sous laparoscopie était plus élevée que celle des patients opérés par chirurgie ouverte.
Conclusion
Ces résultats indiquent que l’insufflation de CO2 pour la cholécystectomie laparoscopique provoque de l’acidose respiratoire causée 1) par la baisse de la compliance, 2) l’augmentation du volume de CO2 et 3) l’insuffisance ventilatoire. L’accumulation du CO2 pendant la cholécystectomie laparoscopique augmente la PaCO2 à la salle de réveil.
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Iwasaka, H., Miyakawa, H., Yamamoto, H. et al. Respiratory mechanics and arterial blood gases during and after laparoscopic cholecystectomy. Can J Anaesth 43, 129–133 (1996). https://doi.org/10.1007/BF03011253
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DOI: https://doi.org/10.1007/BF03011253