Respiratory mechanics during laparoscopic cholecystectomy: the effects of the abdominal wall lift

Autor: Pierre Baconnier, François Y, Gallet D, J. P. Perdrix, Banssillon, Gilly F, Sayag A, Carry Py, A Eberhard
Rok vydání: 1998
Předmět:
Zdroj: Anesthesia and analgesia. 87(6)
ISSN: 0003-2999
Popis: The abdominal wall lift (AWL) has been proposed for laparoscopic cholecystectomy to reduce hemodynamic effects caused by carbon dioxide (CO 2 ) and high intraabdominal pressures (IAP). Data concerning effects of AWL on respiratory mechanics are scant. We therefore used a noninvasive method to evaluate whether the AWL could offset these effects. The PETCO 2 , airflow, and airway pressure were continuously measured in nine patients undergoing laparoscopic cholecystectomy using an AWL with minimal CO 2 insufflation. We used a least-squares method to calculate maximal airway pressure (Pmax), elastance (Ers), and resistances (Rrs) of the respiratory system. After CO 2 insufflation, the initiation of AWL resulted in a significantly decreased IAP (from 13 to 6 mm Hg; P < 0.001) and Rrs (from 20.6 to 17.8 cm H 2 O. L -1 .s -1 ; P = 0.029), whereas Ers was partly modified (34.0 to 33.3 cm H 2 O/L; not significantly different). With AWL, we hypothesized that the diaphragm remained flat and stiff, outweighing the beneficial effect of the decrease of IAP on Ers. PETCO 2 significantly increased after AWL and at the end of the procedure. We conclude that AWL partly reverses the impairment of the respiratory mechanics induced by CO 2 insufflation during laparoscopic surgery. Implications: The abdominal wall lift (AWL), acting on the abdominal chest wall, had some benefits during laparoscopic surgery by limiting CO 2 peritoneal insufflation and several side effects, such as hemodynamics. We examined the consequences of this technique on respiratory mechanics in nine patients undergoing laparoscopic cholecystectomy. Our findings suggest that the AWL decreases intraabdominal pressure and respiratory resistances without a significant effect on respiratory elastance.
Databáze: OpenAIRE
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