Larriva-Cerda MÁ, Valero-Gómez J, Alberto-Barrientos L, Castilleja-Leal F, Alonso-Morales L, González-Estavillo AC, Ortega-Suárez L, Larriva-Cerda ÓA, García-Espíndola ÓI

Language: Spanish
References: 9
Page: 181-185
PDF size: 77.62 Kb.

ABSTRACT

The anesthetic management has been fitted to the needs of the laparoscopic surgery, as a way to keep the blood CO₂ levels in between the physiologic needs. The equilibrium between the production and elimination of this gas, seems to be affected by the introduction of a large amount of CO₂ in the abdominal cavity, gas normally used in this surgery to insuflate and start a pneumoperitoneum. The purpose of this study is to know the adequate parameters in the pressure controlled ventilation in laparoscopic surgery and make a comparison against the volume controlled ventilation to determine in wich of the 2 modes establish a diminutive end tidal CO₂. The sample size was 92 patients between 18 and 80 years old with an ASA I-II classification, who didn’t present cardiopulmonary illness and were programmed for laparoscopic cholecystectomy. The total of the patients were randomly divided into 2 groups of 46 patients each, they all were managed by general anesthesia and every group was assigned with a ventilation mode. The measured parameters at the beginning, during, and at the end of the pneumoperitoneum were oxygen saturation, cardiac frequency, blood pressure, tidal volume, minute volume, air way pressures, end tidal CO₂, and intraabdominal pressure. The statistical analysis was realized by panel data with random effects, analyzed by the program STATA 11. There were found significant differences in the levels of end tidal CO₂,being lower in the pressure controled ventilation group, and even more markedly in female patients.

REFERENCES

1. Sabiston D. Tratado de patología quirúrgica. (15ª Ed). Vol. 1 y 2. México: McGraw-Hill Interamericana. 1999.

2. Desmond J, Gordon R. Ventilation in patients anaestethized for laparoscopy. Canadian Journal of Anaesthesia 1970;17:378-387.

3. Streich B, Decailliot F, Perney C, Duvaldestin P. Increased carbon dioxide absorption during retroperitoneal laparoscopy. British Journal of Anaesthesia 2003;91:793-796.

4. Balick-Weber CC, Nicolas P, Hedreville-Montout M, Blanchet P, Stephan F. Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a crossover study with echocardiographic assessment. British Journal of Anaesthesia 2007;99:429-435.

5. Sprung J, Whalley D, Falcone T, Wilks W, Navratil J, Bourke D. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesthesia & Analgesia 2003;97:268–274.

6. Henzler D, Pelosi P, Dembinski R, Ullman A, Mahnken A, Rossaint R, Kuhlen R. Respiratory compliance but not gas exchange correlates with changes in lung aeration after a recruitment maneuver: an experimental study in pigs with saline lavage lung injury. Critical Care 2005;9:471-482.

7. Miner J, Heegard W, Plummer D. End-tidal Carbon Dioxide Monitoring during Procedural Sedation. Academic Emergency Medicine 2002;9:275-280.

8. Lloréns J, Ballester M, Tusman G, Blasco L, García-Fernández J, Jover JL, Belda FJ. Adaptative support ventilation for gynaecological laparoscopic surgery in Trendelemburg position: Bringing ICU modes of mechanical ventilation to the operating room. European Journal of Anaesthesiology 2009;26:135-139.

9. Bhavani-Shankar K, Steinbrook R, Brooks D, Datta S. Arterial to end-tidal carbon dioxide pressure difference during laparoscopic surgery in pregnancy. Anesthesiology 2000;93:370.