Anaesthetic Management and Physiologic Effects of Pneumoperitoneum in Patients With Chronic Obstructive Pulmonary...

This study aimed to assess the physiological changes and clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) undergoing laparoscopic cholecystectomy.

This prospective cohort study included 50 patients of the American Society of Anesthesiology (ASA) physical status I and II with mild to moderate COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I-II) scheduled for laparoscopic cholecystectomy. We monitored heart rate, mean arterial pressure, end-tidal carbon dioxide (EtCO₂), arterial carbon dioxide (PaCO₂), and bicarbonate (HCO₃) levels at baseline, 30 minutes after induction or 15 minutes post-insufflation, 15 minutes post-deflation, and 60 minutes post-operative. Perioperative complications and post-operative recovery characteristics were also observed. Descriptive statistics were used to summarise the demographic and clinical characteristics of the patients. The correlation between HCO₃ and EtCO₂ was plotted on a scatterplot, and Pearson's correlation 'r' was calculated. The changes in physiological parameters over time were analysed using a paired t-test. A p-value of less than 0.05 is considered statistically significant.

We observed a statistically significant but transient increase in heart rate, mean arterial pressure, and EtCO₂ at 30 minutes after induction or 15 minutes post-insufflation, which returned to baseline levels within 15 minutes of deflation. Similarly, arterial CO₂ and bicarbonate levels were also significantly increased at 15 minutes post-insufflation, yet remained within the normal physiological range. The study reported no serious perioperative complications, and all patients had an uneventful recovery.

While patients with mild to moderate COPD can experience transient physiological changes during laparoscopic cholecystectomy, these changes are generally well-tolerated and not associated with adverse clinical outcomes. Therefore, laparoscopic cholecystectomy can be considered a safe procedure in these patients. Future research should focus on the implications and safety of this procedure in patients with severe COPD.