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Ventilatory requirements during laparoscopic cholecystectomy

R W Wahba1, J Mamazza

  • 1Department of Anaesthesia, Queen Elizabeth Hospital, Montreal, Qué.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|March 1, 1993
PubMed
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Laparoscopic cholecystectomy requires increased minute ventilation to maintain normal arterial carbon dioxide levels. End-tidal PCO2 is an unreliable indicator of arterial carbon dioxide during this procedure.

Area of Science:

  • Anesthesiology
  • Surgical Physiology
  • Respiratory Medicine

Background:

  • Laparoscopic surgery, particularly cholecystectomy, involves creating a pneumoperitoneum.
  • Pneumoperitoneum can alter respiratory mechanics and gas exchange.
  • Maintaining adequate ventilation is crucial during anesthesia.

Purpose of the Study:

  • To quantify the increase in minute ventilation needed to maintain preinsufflation arterial carbon dioxide tension (PaCO2) during laparoscopic cholecystectomy.
  • To evaluate the reliability of end-tidal PCO2 (PETCO2) as an index of PaCO2 during pneumoperitoneum.

Main Methods:

  • 28 healthy adults (ASA class 1 and 2) undergoing laparoscopic cholecystectomy were studied.
  • Measurements included PaCO2, PETCO2, expired minute volume (Vexp), and airway pressures before and after CO2 pneumoperitoneum.

Related Experiment Videos

  • Patients were in reverse Trendelenburg with a lateral tilt.

    • Main Results:

    • Expired minute volume increased significantly to maintain PaCO2 near baseline levels.
    • PETCO2 was often lower than PaCO2, with a significant gradient in some patients.
    • The difference between PaCO2 and PETCO2 (Pa-PETCO2) varied, indicating PETCO2 is an imperfect index.

    Conclusions:

    • Laparoscopic cholecystectomy necessitates an increased ventilatory requirement.
    • PETCO2 is not a consistently accurate surrogate for PaCO2 during laparoscopic procedures.
    • Anesthesiologists should be aware of the limitations of PETCO2 monitoring in this setting.