Abstract
Objective. To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2), arterial blood gases (ABG), and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF) during laparoscopic cholecystectomy (LC) by using lung-protective ventilation strategy. Materials and Methods. Forty-six patients undergoing LC and abdominal wall hernia (AWH) surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery. Results. Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS), arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group. Conclusions. Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.
Highlights
The increasing number of indications of laparoscopic surgery, which is the gold standard approach in several diagnostic and therapeutic procedures, means that anesthesiologists need to have a better understanding of the physiological effects and potential complications of pneumoperitoneum [1]
We evaluated the effects of pneumoperitoneum at an intra-abdominal pressure (IAP) level (
In laparoscopic cholecystectomy (LC) group, there was a significant increase in the peak inspiratory pressure (PIP), ETCO2, and pCO2 values (P < 0.023, P < 0.0001, and P < 0.001, resp.), and there was a significant decrease in the Cdyn, pH, and pO2 values at 30 min compared to baseline values (P < 0.0001, P < 0.001, and P < 0.0001, resp.) (Table 2)
Summary
The increasing number of indications of laparoscopic surgery, which is the gold standard approach in several diagnostic and therapeutic procedures, means that anesthesiologists need to have a better understanding of the physiological effects and potential complications of pneumoperitoneum [1]. Laparoscopic surgery, a minimal invasive technique, has substantial effects on the hemodynamic and respiratory system, even in healthy individuals, it has many advantages compared to conventional open surgical techniques. These pathophysiological effects result in an increased risk of perioperative and postoperative complications in elderly patients with impaired cardiac and pulmonary functions [2, 3]. During laparoscopy, increasing intra-abdominal pressure (IAP) with abdominal CO2 insufflation causes ischemia through splanchnic vasoconstriction and subsequent reperfusion injury through deflation [2]. Hypercarbia and acidosis can occur because of ventilation-perfusion mismatch caused by impaired gas exchange due to increased IAP or absorption of insufflated CO2. Hypercarbia and acidosis affect serum oxidative stress markers and lead to altered hemodynamics [4, 5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
