Rauh R, Hemmerling TM, Rist M, Jacobi K (2001)
Publication Language: English
Publication Type: Journal article, Original article
Publication year: 2001
Book Volume: 13
Pages Range: 361-365
Journal Issue: 5
DOI: 10.1016/S0952-8180(01)00286-0
Study Objective: To investigate the influence of pneumoperitoneum (PP) and posture on respiratory compliance and ventilation pressures. Design: Prospective, single blind trial.Patients: 10 female ASA physical status I and II patients scheduled for elective gynecologic laparoscopy. Setting: University medical center.Interventions: Anesthesia was performed as total IV anesthesia (TIVA) with propofol, alfentanil, and atracurium. After induction of anesthesia and orotracheal intubation, the lungs were ventilated to maintain partial pressure of CO 2 (P ETCO 2) of 30 ± 3 mmHg. Ventilation was kept constant. As gas mixture oxygen and air 1:1 was used without positive end-expiratory pressure (PEEP). Measurements: Measurements were taken before and after creation of pneumoperitoneum with an intraabdominal pressure (IAP) of 10 mmHg, of 15 mmHg in 20° head-down tilt, then in 20° head-up tilt, and after deflation of PP. We determined peak inspiratory pressure (PIP), mean airway pressure (mPaw), P ETCO 2 , expiratory minute volume (V̇ E), heart rate (HR), and systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP). Respiratory system compliance (C eff rs) was calculated as quotient of tidal volume (V T) and PIP. Main Results: After creation of PP (IAP 10 mmHg), there was a significant increase of median PIP (3 cmH 2O), mPaw (1 cm H 2O) and arterial pressure (BP), (MAP by 7 mmHg), C eff rs decreased by 6 mL · cm H 2O -1. Increase of IAP to 15 mmHg led to a further increase of PIP (2 cm H 2O) and mPaw (1 cm H 2O), and a further decrease of C eff rs by 5 mL cm H 2O -1; BP decreased (MAP by 5.5 mmHg). Head-up or head down positions showed no significant hemodynamic or pulmonary changes. P ETCO 2increased from 29.5 to 36 mmHg at an IAP of 15 mmHg, but then no further changes were noticed. Five minutes after deflation of pneumoperitoneum all values returned to baseline levels. Conclusions: Creation of PP at an IAP of 15 mmHg reduced respiratory system compliance, and increased peak inspiratory and mean airway pressures, which quickly returned to normal values after deflation. Head-down or head-up position did not further alter those parameters. Copyright © 2001 Elsevier Science Inc.
APA:
Rauh, R., Hemmerling, T.M., Rist, M., & Jacobi, K. (2001). Influence of pneumoperitoneum and patient positioning on respiratory system compliance. Journal of Clinical Anesthesia, 13(5), 361-365. https://doi.org/10.1016/S0952-8180(01)00286-0
MLA:
Rauh, Robert, et al. "Influence of pneumoperitoneum and patient positioning on respiratory system compliance." Journal of Clinical Anesthesia 13.5 (2001): 361-365.
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