Arterial blood gas and haemodynamic changes due to pneumoperitoneum in laparoscopic cholecystectomy

Autor: Andreas Manouras, I. Bramis, I. Androne, E. Tsounaki, V. Katergianakis
Rok vydání: 2012
Předmět:
Zdroj: Hellenic Journal of Surgery. 84:236-242
ISSN: 1868-8845
0018-0092
DOI: 10.1007/s13126-012-0035-8
Popis: Pneumoperitoneum leads to multiple changes in the mechanics of respiration and heart function, and it causes subcutaneous emphysema, pneumothorax, pneumomediastinum and carbon dioxide embolism. The aim of this project is to study the arterial blood gas and haemodynamic changes due to pneumoperitoneum in laparoscopic cholecystectomy, given the fact that all other parameters are standardized. The haemodynamic changes and blood gas changes in 200 patients that underwent laparoscopic cholecystectomy were studied preoperatively, intraoperatively (15 to 20 minutes after the establishment of pneumoperitoneum) and on the 1st postoperative day. All patients in our study had normal temperature, suffered no blood loss during the operation and did not need blood transfusion intraoperatively or postoperatively. They had the same anaesthetic parameters, were without pain, and measurements were performed under the same standardized procedures. Analgesics and IV fluid administration was standardized for all patients. Patients with respiratory system diseases, cardiovascular diseases and patients under treatment with b-blockers were excluded. The statistical analysis used for measurements of blood gas alterations and haemodynamic changes was paired samples t-test and the normality of the distributions was checked with the Kolmogorof-Smirnov test. Three comparisons of arterial blood gases and haemodynamic measurements were performed: 1) preoperatively vs. intraoperatively, 2) preoperatively vs. 1st postoperative day and 3) intraoperatively vs. 1st postoperative day. Systolic and diastolic blood pressure and pulse reduced intraoperatively and during the 1st postoperative day, whereas it increased between the 1st postoperative day and intraoperatively. pCO2 and base excess increased in all measurements; pO2 reduced during the 1st postoperative day and between the 1st postoperative day and intraoperatively, and increased intraoperatively; pH reduced in all measurements; SO2 and bicarbonate increased intraoperatively, reduced during the 1st postoperative day and between the 1st postoperative day and intraoperatively. Haematocrit and haemoglobin reduced intraoperatively, during the 1st postoperative day, and increased between the 1st postoperative day and intraoperatively. Based on all the above, we reached the conclusion that, with the exception of the increase in pO2 intraoperatively due to mechanic ventilation and the decrease of haematocrit and haemoglobin intra- and postoperatively as a result of fluid administration, all other changes occurred as a result of the pneumoperitoneum.
Databáze: OpenAIRE
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