Abstract
The purpose of this clinical study was to determine: (1) the increase in minute ventilation required to maintain preinsufflation arterial carbon dioxide tension (PaCO2) during laparoscopic cholecystectomy, and (2) whether end-tidal PCO2 (PetCO 2) can be used as an index of PaCO2 and, therefore, of the adequacy of minute ventilation during the pneumoperitoneum. We measured PaCO2,PetCO 2, expired minute volume (Vexp) standardized for body surface area (SA), airway and intra-abdominal pressure (Paw, Pabd) during general anaesthesia for laparoscopic cholecystectomy just before and 30 min after the creation of a CO2 pneumoperitoneum in 28 healthy (ASA class 1 and 2) consenting adults. They were in the reverse Trendlenburg position (20°) with a 5° lateral tilt. Expired minute volume was increased from 3.75 (SEM ± 0.12) to 4.19 (0.15) L·min−1·m−2 to maintain PaCO2 close to control levels: 38.9 (0.8) vs 40.1 (0.6) mmHg 5.19 (0.1) vs 5.35 (0.08) kPa). In most of the patients (23/28),PetCO 2 was less than 41 mmHg with a correlation between PaCO2 andPetCO 2. In ten of these patients, (Pa-Pet)CO2 was greater than the normal range. In 5/28, (Pa-Pet)CO2 was negative. The “driving pressure” (Paw-Pabd) increased from 8.7 (1.0) to 10.4 (1.1) cm H2O, without any correlation between the increase in Paw-Pabd and that in\(\dot Vexp\). The results indicate the need for extra ventilatory requirement during laparoscopy and thatPetCO 2 is an imperfect index of PaCO2 under these circumstances.
Résumé
Cette étude clinique visait à déterminer: (1) l’augmentation de ventilation-minute nécessaire à maintenir au niveau préinsufflation la pression artérielle en gaz carbonique (PaCO2) pendant la cholécystectomie laparoscopique; (2) si la mesure de la PaCO2 télé-expiratoire(PetCO 2) peut être utilisée comme un indicateur de la PaCO2 et en conséquence de l’efficacité ventilatoire pendant le pneumopéritoine. Nous avons mesuré la PaCO2, laPetCO 2, le volume-minute expiré (V exp) normalisé à la surface corporelle, la pression sur les voies respiratoires et la pression abdominale (Paw, Pabd) pendant l’anesthésie générale administrée pour cholécystectomie par laparoscopie immédiatement avant et 30 minutes après la création du pneumopéritoine avec du CO2 chez 28 adultes non tarés, consentant et classés ASA 1 et 2. Ils étaient en position Trendélembourg inversé (20°) avec une inclinaison latérale de 5°. Nous avons augmenté le volume expiré de 3,75 (SEM ± 1,12) à 4,19 (0,05) L·min−1·m−2 de façon à maintenir la PaCO2 près du niveau des contrôles: 38,9 (0,8) vs 40,1 (0,6) mmHg. Pour la plupart des patients (23/28), laPetCO 2 fut inférieure à 41 mmHg avec une bonne corrélation entre PaCO2 etPetCO 2. Pour dix de ces patients, la (PaCO2-PetCO 2) dépassait les valeurs normales. Chez 5/28, la (Pa-Pet)CO2 était négative. La pression effective (Paw-Pabd) a augmenté de 8,7 (1,0) à 10,4 (1,1) cm H2O sans corrélation entre l’augmentation de la différence Paw-Pabd et celle de\(\dot V_{exp} \). Ces résultats démontrent qu’il faut augmenter la ventilation pendant la laparascopie et que laPetCO 2, dans ces circonstances, ne réflète pas toujours la PaCO2.
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Wahba, R.W.M., Mamazza, J. Ventilatory requirements during laparoscopic cholecystectomy. Can J Anaesth 40, 206–210 (1993). https://doi.org/10.1007/BF03037031
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DOI: https://doi.org/10.1007/BF03037031