[Influence of cardiac or respiratory pathology in the gasometric evolution during laparoscopic cholecystectomy]

To analyze the differences in gasometric behavior during laparoscopic cholecystectomy in patients with heart or respiratory disease.

Prospective study of 19 ASA III patients grouped according to whether they suffered heart (group H, n = 10) or respiratory (group R, n = 9) disease. The patients were ventilated without reabsorption of CO2 and a flow volume of 12 ml/kg in order to achieve a positive end tidal pressure of CO2 (PetCO2) between 25 and 30 mmHg and no subsequent changes in ventilatory parameters. Arterial and venous gasometric values, PetCO2, hemodynamic data and airway pressure were analyzed at the following times: T1, 15 min after induction; T2, 20 min after insufflation; and T3, 5 min after de-insufflation.

PaO2 was significantly higher in group R than in group C (238 +/- 31 versus 196 +/- 32 mmHg, respectively, p = 0.015). PaCO2 rose gradually in both groups and the increase was significant between T1 and T2 (group C: 30 +/- 4 to 34 +/- 3 mmHg, p = 0.008; group R: 31 +/- 6 to 35 +/- 5 mmHg, p = 0.032). PvCO2 rose significantly in group C (39 +/- 4 to 42 +/- 4 mmHg, p = 0.001). The arteriovenous differences in CO2 increased in group C between T2 and T3 (6 +/- 3 to 11 +/- 6 mmHg) but the difference was not significant. PetCO2 increased after pneumo-peritoneum in group C (26 +/- 3 to 30 +/- 4 mmHg, p = 0.003). The arterial-PetCO2 gradient did not change.

Laparoscopic cholecystectomy is a safe technique for use in patients with cardio-respiratory risk factors, even though there is a gradual increase in PaCO2. Physiological changes were greater in the patients with heart disease.