Effects of propofol vs isoflurane on respiratory gas exchange during laparoscopic cholecystectomy

Gehring, Hartmut; Kuhmann, K.; Kf, Klotz; Ocklitz, Evelyn; Roth-Isigkeit, Angela; Sedemund-Adib, Beate; Schmucker, P.

doi:10.1111/j.1399-6576.1998.tb05107.x

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…These patients may also bene®t from prolonged postoperative mechanical ventilation [160]. From a more surgical standpoint, gasless laparoscopy or the use of other gases (e.g., helium and N 2 O) may have clinically relevant advantages (1b [28,155,159,224]), but the results of randomized trials are inconsistent (1b [92]) and need to be con®rmed. Trocar positioning also has a relevant in¯uence on pulmonary function, (1a [167]).…”

Section: Lung Physiology and Gas Exchangementioning

confidence: 98%

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

et al. 2002

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Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

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Section: Lung Physiology and Gas Exchangementioning

confidence: 98%

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

et al. 2002

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“…Nevertheless, isoflurane leads to a smaller PaO2 and higher PaCO2 than propofol during laparoscopic cholecystectomy (38). Possibly, the maintenance of the hypoxic pulmonary vasoconstriction by propofol may explain this finding (91).…”

Section: Anesthesiamentioning

confidence: 84%

“…The origin of this variation is not clear, though. Putative candidates to explain this phenomenon are: redistribution of the V'/Q' ratios throughout the lung (that occurs during anesthesia), decubitus, and the variable efficiency of the hypoxic pulmonary vasoconstriction produced by the anesthetic drugs (5,(38)(39)(40). Interestingly, the degree of atelectasis during pneumoperitoneum is associated with the PaCO2-Pet-CO2 gradient, but not with the PaO2/FiO2 ratio (41).…”

Section: Alterations Of the Respiratory Systemmentioning

confidence: 99%

Artificial ventilation during pneumoperitoneum

Comuzzi¹

2014

SOB

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the complications pertaining to pneumoperitoneum to solve them quickly, paying particular attention to the patients at higher risk, such as elderly, obese, and those with cardiopulmonary disease. KEY WORDS: pneumoperitoneum, artificial ventilation, obesity, laparoscopy, anesthesia. IntroductionLaparoscopic surgery has been increasingly employed in various surgical subspecialties because of its innumerous benefits. These are evident during the post-operative period and result from the less important organ/tissue trauma caused by laparoscopic approaches than those triggered by open surgery. The main advantages of laparoscopic surgery are: reduction of the inflammatory and metabolic responses (1-3), reduced post-operative pain and analgesic consumption (2, 3), smaller incidence of respiratory complications (2), faster resolution of post-operative ileum and recovery (1). Taken together, these outcomes reduce hospital stay, promote a quicker return to normal daily activities (2-4), and reduce the cost of the treatment (4). On the other hand, laparoscopic surgery presents some challenges regarding the intra-operative anesthesia management, since there are respiratory and hemodynamic changes pertaining to the general anesthesia itself, to the abdominal insufflation, and to the intra-operative positioning of the patient (5). These issues become even more evident in patients with cardiopulmonary disease or obesity (6). This review focuses on the intra-operative respiratory alterations caused by laparoscopy and on the ventilatory strategies that are prone to minimize the modifications evoked by the technique. Alterations of the respiratory systemIn order to allow an adequate observation of the surgical field, laparoscopic surgery requires controlled gas insufflation into the peritoneal cavity (pneumoperitoneum). For this purpose, carbon dioxide is regularly used under a pressure of 10-15 mmHg. Naturally, respiratory issues related to mechanics and CO2 overload SummaryLaparoscopic surgery has been increasingly used in many surgical subspecialties, due to its various post-operative benefits. On the other hand, it presents intra-operative challenges to the anesthesia management. The inflation of the abdominal cavity with carbon dioxide leads to hemodynamic changes, mechanical respiratory system derangements (increased elastance, resistance and airway pressure), augmented V'CO2, and alterations of the V'/Q' ratio and of the PaCO2-PetCO2 gradient. All these changes may be influenced by other factors, such as body position and baseline characteristics of the patient. To minimize the negative consequences of these modifications a protective ventilation strategy with the use of low tidal volumes and PEEP, eventually associated with recruitment maneuvers, is suggested. No ventilatory mode or anesthetic drug has been proven better than the others. It has been suggested that the use of supraglotic devices may be a safe alternative to endotracheal intubation during laparoscopic surgery. It is important that the anesthetist be aware ...

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“…The physiological disadvantages of prolonged anesthesia have been widely discussed and include, among others, arrhythmias, myocardial depression, hypotension and hypoxia 29,30 . There is association between the higher incidence of pulmonary complications in the postoperative period of abdominal surgery with an average time of surgery exceeding 210 minutes 31 .…”

Section: Resultsmentioning

confidence: 99%

Pulmonary function in women: comparative analysis of conventional versus single-port laparoscopic cholecystectomy

Borges

Gouvea

Marcacini

et al. 2018

Rev. Col. Bras. Cir.

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Effects of propofol vs isoflurane on respiratory gas exchange during laparoscopic cholecystectomy

Cited by 15 publications

References 10 publications

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

Artificial ventilation during pneumoperitoneum

Pulmonary function in women: comparative analysis of conventional versus single-port laparoscopic cholecystectomy

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