Document Detail

Influence of pneumoperitoneum and patient positioning on respiratory system compliance.
MedLine Citation:
PMID:  11498317     Owner:  NLM     Status:  MEDLINE    
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(ET)CO(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 degrees head-down tilt, then in 20 degrees head-up tilt, and after deflation of PP. We determined peak inspiratory pressure (PIP), mean airway pressure (mPaw), P(ET)CO(2), expiratory minute volume (V(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(2)O), mPaw (1 cm H(2)O) and arterial pressure (BP), (MAP by 7 mmHg), C(eff rs) decreased by 6 mL. cm H(2)O(-1). Increase of IAP to 15 mmHg led to a further increase of PIP (2 cm H(2)O) and mPaw (1 cm H(2)O), and a further decrease of C(eff rs) by 5 mL cm H(2)O(-1); BP decreased (MAP by 5.5 mmHg). Head-up or head down positions showed no significant hemodynamic or pulmonary changes. P(ET)CO(2)increased 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.
R Rauh; T M Hemmerling; M Rist; K E Jacobi
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  13     ISSN:  0952-8180     ISO Abbreviation:  J Clin Anesth     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-08-10     Completed Date:  2001-10-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  361-5     Citation Subset:  IM    
Department of Anesthesiology, University of Erlangen-Nuremberg, Nuremberg, Germany.
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MeSH Terms
Anesthesia, Intravenous
Blood Pressure / physiology
Gynecologic Surgical Procedures
Heart Rate / physiology
Lung Compliance / physiology*
Pneumoperitoneum / physiopathology*
Posture / physiology*
Respiration, Artificial
Respiratory Mechanics / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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