Changes in respiratory compliance at laparoscopy: measurements using side stream spirometry

Area of Science:

• Anesthesiology
• Respiratory Physiology
• Surgical Innovation

Background:

• Laparoscopic surgery utilizes peritoneal insufflation, which can impact respiratory mechanics.
• Understanding changes in total respiratory compliance (Crs) is crucial for patient safety during these procedures.

Purpose of the Study:

• To quantify the effects of peritoneal pressurization on Crs during laparoscopic abdominal surgery.
• To investigate how surgical type and patient positioning influence Crs changes.

Main Methods:

• Measured Crs in 32 patients undergoing laparoscopic cholecystectomy, gastric fundoplication, or inguinal hernia repair.
• Utilized side stream spirometry under standardized anesthetic conditions.
• Assessed Crs changes at baseline, during CO2 insufflation (11 cmH2O), and after deflation, considering patient position (horizontal, head-up, head-down tilt).

Main Results:

• Peritoneal pressurization caused an immediate 20% decrease in Crs across all surgical groups (P < 0.05-0.01).
• Inguinal hernia repair in the head-down position showed the most significant Crs deterioration (P < 0.05).
• Cholecystectomy and fundoplication patients (head-up position) had immediate Crs recovery post-deflation, unlike hernia patients (P < 0.05).

Conclusions:

• Peritoneal pressurization during laparoscopic surgery significantly reduces Crs.
• Patient positioning and surgical type influence the magnitude and recovery of Crs changes.
• Demographic factors and intraabdominal pressure did not correlate with observed Crs alterations.