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Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 30-35

Respiratory and hemodynamic effects of positive end-expiratory pressure during capnoperitoneum for laparoscopic cholecystectomy

Department of Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India

Correspondence Address:
Prof. Parthasarathy Srinivasan
Department of Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_139_19

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Background: General anesthesia, muscle paralysis, and increased intra-abdominal pressure are known to produce basal lung atelectasis and may contribute to the inadequate CO2removal and increased end-tidal carbon dioxide (EtCO2)during laparoscopic surgery. Positive end-expiratory pressure (PEEP) has been shown to prevent compression atelectasis during general anesthesia. Hence, we designed this study to test the hypothesis that the application of PEEP before capnoperitoneum will maintain EtCO2 within the normal range without changing the ventilator parameters. Our secondary outcome measures were hemodynamic changes during PEEP and capnoperitoneum. Methods: Sixty patients were randomly allocated to receive 0 PEEP (n = 30) or 10 PEEP (n = 30) with constant minute ventilation under standardized general anesthesia. Respiratory and hemodynamic parameters were recorded every 2 min for 10 min then every 5 min till 30 min after capnoperitoneum. Results: In group PEEP-0, the mean EtCO2increased significantly after 2 min of capnoperitoneum, plateaued at 15 min, remained at high level till 30 min (34.1 ± 3.1 to 43.3 ± 2.9 mmHg; P = 0.000). In group PEEP-10, EtCO2dropped from the baseline (36.5 ± 3.2 to 32.0 ± 3.3 mmHg; P = 0.0003) at 5 min after the application of PEEP, and there was no net increase in EtCO2following capnoperitoneum till 30 min (34.5 ± 3.5 mmHg). Cardiac output fell significantly after the induction in both groups but did not fall any further after the application of PEEP and capnoperitoneum. Conclusion: The application of PEEP of 10 cm H2O before the creation of capnoperitoneum can maintain EtCO2within the normal range without making changes in the ventilator parameters, with stable hemodynamics in patients undergoing laparoscopic cholecystectomy.

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