López-Herranz GP, Castro-Garduño AM

Language: Spanish
References: 16
Page: 25-29
PDF size: 198.61 Kb.

ABSTRACT

Objective: In this study, it is compared the difference between the arterial partial pressure and the end espiratory carbon dioxide pressure in patients with and without cardiopulmonar disease for elective laparoscopic cholecystectomy. Methods: In a prospective, longitudinal, observational and comparative study, forty patients were assigned in two groups. Group I, 20 healthy patients and group II, 20 patients with cardiovascular and/or pulmonary disease. All of them received general anesthesia. Simultaneously, obtained CO₂ arterial pressure by analysis of arterial blood gas and the end of espiration CO₂ through capnography; preinsufflation of CO₂, and fifteen minutes after capnoperitoneum began. The last, when the procedure was concluded. Results: In relation to sex and age no significant difference was established between group I and group II. The arterial and the end espiratory pressure of CO₂ difference in values were: preinsuflation in the group I was 2.8 mm Hg, in the capnoperitoneum 2.9 mm Hg and postinsuflation 3.6 mm Hg. In the group II, the results were: 5.5, 8.1 and 9.9 mm Hg respectively (p ‹ 0.05). In the group II, the pH decreased. Conclusions: The laparoscopic cholecystectomy with capnoperitoneum is related with an important increased in the arterial and end tidal carbon dioxide pressure difference, specially in patients with cardiovascular and/or pulmonary disease. Therefore the invasive monitoring is justified.

REFERENCES

1. Kendall AP, Bhatt S, Oh TE. Pulmonary consequences of carbon dioxide insufflation for laparoscopic cholecystectomies. Anaesthesia 1995; 50: 286-289.

2. Poulin EC, Breton G, Fortin C, Mamazz J, Robert J. Evaluation of respiratory function in laparoscopic cholecystectomy. Surg Laparosc Endosc 1992; 2: 292-296.

3. Wittgen MC, Andrus HC, Fiztgerald DS, Baudendistel JL, Dahms ET, Kaminski LD. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991; 126: 997-1001.

4. Hodgson C, McClelland RMA, Newton JR. Some effects of peritoneal insufflation of carbon dioxide al laparoscopy. Anaesthesia 1970; 25: 382.

5. Puri GD, Singh H. Ventilatory effects of laparoscopy under general anaesthesia. Br J Anaesth 1992; 68: 211.

6. Biobner M, Felber AR, Gögler S et al. Carbon dioxide uptake from pneumoperitoneum during laparoscopic cholecystectomy. Anesthesiology 1992; 77: A3.

7. Whitesell R, Asiddao C, Gollman D, Jablonski J. Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesth Analg 1981; 60: 508-512.

8. Weingarten M. Vigilancia del anhídrido carbónico y el oxígeno en el sistema respiratorio: Perspectiva de 10 años de trabajo. El Hospital 1992; 48: 26-39.

9. Bhavani-Shankar K, Moseley H, Kumar AY, Delph Y. Capnometry and anaesthesia. Can J Anaesth 1992; 39: 617-632.

10. Brown DR, Fishburnst JI, Roberson VO, Hulka JF. Ventilator and blood gas changes during laparoscopy with local anaesthesia. Am J Obstet Gynecol 1976; 124: 741-745.

11. Yamanaka MK, Sue DY. Comparison of arterial end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure. Chest 1987; 92: 832-835.

12. Nathaniel JS. Effect of nonbiliary problems on laparoscopic cholecystectomy. Am J Surg 1993; 165: 522-526.

13. Brampton WJ, Watson RJ. Arterial to end-tidal carbon dioxide tension difference during laparoscopy. Magnitude and effect of anaesthetic technique. Anaesthesia 1990; 45: 210-214.

14. Makinen MR, Aromaa U. Arterial to end tidal PCO2 difference during carbon dioxide pneumoperitoneum. Acta Anaesth Scand 1993; 37: S100.

15. Fox LG, Hein HAT, Gawey BJ, Hellman CL, Ramsay MAE. Physiologic alterations during laparoscopic cholecystectomy in ASA III-IV patients. Anesthesiology 1993; 79: A55.

16. McKinstry LJ, Perversett RA, Yip RW. Arterial and end tidal carbon dioxide in patients undergoing laparoscopic cholecystectomy. Anesthesiology 1992; 77: A108.