IngentaConnect Effect of CO2 pneumoperitoneum on ventilation-perfusion relations...

Authors: Andersson, L.¹; Lagerstrand, L.²; Thörne, A.³; Sollevi, A.¹; Brodin, L-Å.²; Odeberg-Wernerman, S.¹

Source: Acta Anaesthesiologica Scandinavica, Volume 46, Number 5, May 2002 , pp. 552-560(9)

Abstract:

Background:

Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO₂) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation-perfusion (V˙_A/Q˙) before and during pneumoperitoneum by using the multiple inert gas technique. Methods:

Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The V˙_A/Q˙ relationships were evaluated by the multiple inert gas elimination technique before and during pneumoperitoneum to obtain a direct measure of the pulmonary shunt. Results:

Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO₂ from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low V˙_A/Q˙ was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation. Conclusions:

In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.

Keywords: laparoscopy; multiple inert gas technique; shunt

Document Type: Research article

DOI: 10.1034/j.1399-6576.2002.460513.x

Affiliations: 1: Anaesthesiology and Intensive Care, 2: Clinical Physiology and 3: Surgery, Huddinge University Hospital, Stockholm, Sweden

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Effect of CO2 pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy

Effect of CO₂ pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy