Ventilatory effects of laparoscopic cholecystectomy under general anesthesia

Seiji Ishikawa; Koshi Makita; Takeshi Sawa; Hidenori Toyooka; Keisuke Amaha

doi:10.1007/BF02480034

Ventilatory effects of laparoscopic cholecystectomy under general anesthesia

J Anesth. 1997 Sep;11(3):179-183. doi: 10.1007/BF02480034.

Authors

Seiji Ishikawa¹, Koshi Makita¹, Takeshi Sawa¹, Hidenori Toyooka², Keisuke Amaha¹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113, Tokyo, Japan.
² Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, 305, Ibaraki, Japan.

PMID: 28921108
DOI: 10.1007/BF02480034

Abstract

Purpose: To investigate the ventilatory effect of laparoscopic cholecystectomy in patients under general anesthesia with epidural block.

Methods: We measured arterial blood gas, pulmonary carbon dioxide elimination (0000126;_ECO₂), the dead space/tidal volume ratio (V_D/V_T), and the alveolar-arterial PO₂ difference [(A-a)DO₂] just before and 5, 10, 20, 40, and 80 min after peritoneal insufflation in eight patients who underwent laparoscopic cholecystectomy under general anesthesia with epidural block. The effect of laparoscopic cholecystectomy on these values was evaluated. The patients were ventilated on the controlled mode by Servo 900C with a constant tidal volume (V_T 10ml·kg^-1) and frequency (respiratory rate 12 breaths·min^-1) throughout the study.

Results: After starting peritoneal insufflation the PaCO₂ showed a sudden increase during the initial 10 min of about 4 mmHg followed by a gradual increase thereafter. The increase in000123;_ECO₂ was about 30ml·min^-1 (20%) on average during the initial 20 min, and a plateau was reached within 20-40 min after peritoneal insufflation. Neither V_D/V_T nor (A-a)DO₂ showed significant changes during the study.

Conclusion: These results suggest that (1) transperitoneal absorption of CO₂ may be the main cause of hypercarbia, and the hypercarbia is not attributed to the increase in V_D/V_T; and (2) oxygenation is not impaired during pneumoperitoneum.

Keywords: Alveolar-arterial PO2 difference; Deadspace/tidal volume ratio; Laparoscopic cholecystectomy; Peritoneal insufflation; Pulmonary carbon dioxide elimination.