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Stress responses during laparoscopy with CO2 insufflation and with mechanical elevation of the abdominal wall
B Ishizuka1, Y Kuribayashi, Y Kobayashi
1Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, Japan.
Study Objective:
To compare the intensity of stress responses caused by laparoscopy combined with CO2 insufflation (CI) with those caused by mechanical elevation of the abdominal wall (MEA).
Design:
Prospective study (Canadian Task Force classification I).
Setting:
Tertiary care university hospital.
Patients:
Thirty-one women. Intervention. Laparoscopy, 16 with CI and 15 with MEA.
Measurements And Main Results:
Circulating levels of norepinephrine, epinephrine, cortisol, and interleukin (IL)-6 were compared in the two groups. Arterial partial pressure of CO2 (PaCO2) did not increase during laparoscopy by either method. Plasma norepinephrine and epinephrine levels increased after extubation in the MEA group but not in the CI group. Circulating cortisol levels in both groups increased during laparoscopy; mean intraoperative levels were higher in the CI group. Serum IL-6 levels increased after extubation in the MEA but not the CI group. Mean heart rate increased during laparoscopy in both groups, whereas blood pressure increased only in the CI group. More patients in the MEA group required postoperative analgesia.
Conclusion:
Laparoscopy with MEA caused more pronounced adrenosympathetic and cytokine responses than that with CI when PaCO2 was maintained within the range of normocapnia.
