IngentaConnect Effect of age on pulmonary gas exchange during laparoscopy in the...

Authors: Takahata; Kunisawa¹; Nagashima¹; Mamiya¹; Sakurai²; Fujita³; Fujimoto³; Iwasaki¹

Source: Acta Anaesthesiologica Scandinavica, Volume 51, Number 6, July 2007 , pp. 687-692(6)

Abstract:

Background:

Physiological changes in respiratory mechanics caused by aging may lead to a deterioration in pulmonary gas exchange, an increase in the alveolar-arterial oxygen gradient [(A-a)Do₂] and a difference between the arterial carbon dioxide (CO₂) tension (P_aco₂) and expired end-tidal CO₂ tension (P_ETco₂) [P_(a-ET)co₂] during laparoscopy in the Trendelenburg lithotomy position (TLP). Methods:

The subjects were 51 gynecologic patients. Pressure-controlled ventilation was used to maintain P_ETco₂, measured by the side stream method, within the range 4-4.67 kPa. During laparoscopy with CO₂ insufflation in TLP, the tidal volume was increased to keep P_ETco₂ within ± 20% of the pre-insufflation value. The subjects were divided into three groups by age: young group (< 45 years); middle-aged group (45-64 years); and elderly group (≥ 65 years). Results:

Before pneumoperitoneum (PPN), significant differences were found between the young and elderly groups in the arterial oxygen tension (P_ao₂), (A-a)Do₂, P_aco₂ and P_(a-ET)co₂. In all groups, the peak inspiratory pressure and P_aco₂ increased progressively during PPN in TLP. P_(a-ET)co₂ increased gradually after starting CO₂ insufflation in TLP only in the elderly group. Conclusions:

An increase in P_(a-ET)co₂ was seen during PPN in TLP in the elderly group. With CO₂ insufflation in TLP, the setting of mechanical ventilation based on the value of P_ETco₂ (measured by the side stream method) should be determined with caution in elderly patients.

Keywords: age; laparoscopy; pulmonary gas exchange; side stream method; Trendelenburg position

Document Type: Research article

DOI: 10.1111/j.1399-6576.2007.01311.x

Affiliations: 1: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College, Hokkaido 2: Department of Anesthesia, Nayoro Municipal Hospital, Nayoro 3: Department of Emergency Medicine, Asahikawa Medical College, Hokkaido, Japan

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Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position