Changes in Respiratory Compliance and Peak Airway Pressure during a Laparoscopic Cholecystectomy in the Elderly / 대한마취과학회지

BACKGROUND: The advantage of a laparoscopic cholecystectomy has led to a trend toward performing it in the elderly. It is well recognised that this can cause changes in respiratory mechanics. However, few studies have measured the effects of abdominal insufflation with CO2 in the elderly. This study was done to evaluate changes in respiratory compliance and peak airway pressure during a laparoscopic cholecystectomy. METHODS: Thirty patients undergoing a laparoscopic cholecystectomy were divided into two groups; aged 65 years or more (elderly group) and under 60 years (control group). A pneumoperitoneum up to an intraabdominal pressure of 12 mmHg was created with CO2 insufflation. Respiratory and peak airway pressure were measured with a continuous spirometry. Measurements were obtained pre-insufflation, just after CO2 insufflation, at 15, 30, 45 and 60 minutes and after abdominal deflation. RESULTS: In both groups, respiratory compliance decreased significantly (P < 0.05) and equally by about 40% after CO2 insufflation. The decrement continued during the pneumoperitoneum, the changes were not significant between the groups. Each group showed an equal improvement immediately after abdominal deflation. No differences between the peak airway pressure during a laparoscopic cholecystectomy was seen in either group. CONCLUSIONS: We have demonstrated that during a laparoscopic cholecystectomy in the elderly the respiratory compliance decreased and peak airway pressure significantly increased as in the control group.

Valuability of Propofol as Anesthetics and Effect of Hypercarbia on Awakening after Propofol TCI during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: It used to induce hypercarbia that carbon dioxide insufflated into the peritoneum in laparoscopic surgery. It might stimulate sympathetic nervous system, and decrease splanchnic circulation, hepatic function, and metabolism of anesthetics. The purpose of the present study was to examine the influence of hypercarbia on concentrations of propofol at the time of eye opening and recovery of orientation after propofol target controlled infusion (TCI) during a laparoscopic cholecystectomy. METHODS: Fifty patients were divided randomly into a laparoscopic group (group 1, n = 25) and an exploratory group (group 2, n = 25). A propofol infusion was started at a propofol target concentration of 6microgram/ml, and anesthesia was maintained at 4microgram/ml by using a Diprifusor (TM) turing the operation, intraabdominal pressure was maintained automatically at 12 14 mmHg by a CO2 insufflator and controlled ventilation settings were adjusted about 50 mmHg of PaCO2 after peritoneal insufflation. This ventilatory setting was not changed throughout the operation. We evaluated the estimated plasma concentrations of propofol at the time of eye opening and recovery of orientation in each group using user interface of a Diprifusor (TM). RESULTS: In the laparoscopic group, PaCO2, and PetCO2 increased significantly at 5, 15, 30 minutes after carbon dioxide insufflation, but there was no significant difference in concentrations of propofol at eye opening and orientation after propofol TCI between the two groups. CONCLUSIONS: Hypercarbia induced by insufflation of carbon dioxide into peritoneum didn't give rise to an influence on awakening concentrations after propofol TCI during a laparoscopic cholecystectomy.

The Effects of Intraperitoneal CO2 Insufflation and/or Reversed Trendelenburg Position on Airway Pressure and Compliance / 대한마취과학회지

BACKGROUND: We studied the effects of intraperitoneal CO2 insufflation and/or the reversed Trendelenburg position on airway pressure and compliance of the total respiratory system. METHODS: We selected and randomly allocated eighty adults to a control group C or laparoscopy group L. Without premedication, propofol and vecuronium were injected for anesthesia. In the supine position we checked peak and plateau airway pressures, and calculated the dynamic and static compliance of the total respiratory system. We only used 10o reverse Trendelenburg position in group C, and used both 10o reverse Trendelenburg position and abdominal CO2 insufflation in group L. Afterwards, we checked airway pressure and compliance and compared them between groups. RESULTS: In group C, there was no change in airway pressure and compliance. But in group L, peak airway pressure (13.9 +/- 2.4 vs 21.0 +/- 3.3 cmH2O) and plateau airway pressure (11.7 +/- 2.1 vs 18.9 +/- 3.2 cmH2O) were increased and dynamic compliance (47.7 +/- 9.1 vs 30.6 +/- 5.9 ml/cmH2O) and static compliance (58.4 +/- 12.4 vs 13.1 +/- 7.3 ml/cmH2O) of the total respiratory system were decreased. CONCLUSION: In a laparoscopic cholecystectomy, intraabdominal insufflation of CO2 raises airway pressure and reduces compliance of the total respiratory system. Reverse Trendelenburg position itself does not affect airway pressure and compliance.

Comparison of the Effects of Propofol and Isoflurane Anesthesia on Respiratory Gas Exchange during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Introduction of a pneumoperitoneum using CO2 is accompanied by significant alterations in respiratory function and pulmonary gas exchange during laparoscopic cholecystectomy. Previous studies have shown differing results concerning pulmonary gas exchange: a significant decrease of PaO2 was induced with isoflurane. In contrast, no significant changes were observed with propofol. The purpose of the present study was to compare the effects of propofol vs isoflurane on pulmonary gas exchange during general anesthesia for laparoscopic cholecystectomy. METHODS: Forty patients were divided randomly between isoflurane and propofol groups. After induction of anesthesia, ventilation was controlled and intra-abdominal pressure was maintained automatically at 12 mmHg by a CO2 insufflator. After the measuring of baseline values of blood pressure, heart rate, PaO2, PaCO2 and PetCO2 before CO2 insufflation, measurements were also made immediately, 30min after CO2 insufflation and 5 min after CO2 exsufflation. RESULTS: In the isoflurane group, PaCO2, PetCO2, PaO2, and P(a-et)CO2 changed significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). In the propofol group, PaCO2 and PetCO2 increased significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05), but PaO2 and P(a-et)CO2 remained constant. When the two groups were compared, there were significant differences in PaO2, PaCO2, PetCO2 and P(a-et)CO2 at 30min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). CONCLUSIONS: These results indicate that during laparoscopic cholecystectomy the PaO2 was significantly lower and PaCO2 and P(a-et)CO2 were significantly higher in the isoflurane group compared with the propofol group.

The Effect of 0.5% Bupivacaine Instillation for the Postoperative Pain after Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although post operative pain has been reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate abdominal and shoulder pain after surgery. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to three groups by simple randomization(12 patients per group). Group I patients(control) had no specific treatment, group II patients had 10 ml of normal saline instillation, and group III patients had 10 ml of 0.5% bupivacaine instillation. Instillation was made directly into the gallbladder bed and right subdiaphragmatic space under direct vision by the surgeon at the end of the procedure and before evacuating the pneumoperitoneum. RESULT: Compared to that of the group I, VAS of group II and III did not show any statistically significant difference. Compared to the group I, group II & III showed no significant difference in numbers of requests of Tiaprofenic acid during the 36hours after the surgery. CONCLUSION: Topical instillation of 0.5% bupivacaine 10 ml to the gallbladder bed and right subdiaphragmatic space after laparoscopic cholecystectomy is not effective for the post operative pain control.

Subcutaneous Emphysema and Hypercarbia Following Laparoscopic Cholecystectomy by Increased Intraabdominal Pressure: A case report / 대한마취과학회지

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.

The Topical Intraperitoneal Anesthesia of 0.5% Bupivacaine Before Laparoscopic Cholecystectomy is Effective on the Postoperative Pain Control / 대한마취과학회지

BACKGROUND: Recently, laparoscopic cholecystectomy becomes more favorite method than traditional open cholecystectomy. But postoperative pain control is still remaining problem. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to two groups by simple randomization (15 patients per group). Group C (control) had no specific treatment and group B (bupivacaine) received 20 ml of 0.5% bupivacaine with epinephrine 1:200,000 before surgery. Immediately after the creation of a pneumoperitoneum, the surgeon sprayed the bupivacaine near and above the operation field. Operation was started 10 minutes after then. We attempted to investigate that the degree of postoperative pain which was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) in the recovery room at postoperative 1 h., as well as the analgesic requirements during the first 24 h. postoperatively. RESULT: VRS of group B was significantly lower than group C (p<0.05), but VAS was not significantly different. Six patients in group B and only one in group C requested no analgesics. Group C had statistically more frequent request for analgesics than group B (p<0.05). CONCLUSION: The topical intraperitoneal anesthesia of 20 ml of 0.5% bupivacaine with epinephrine 1 : 200,000 before laparoscopic cholecystectomy is effective on the postoperative pain control. So, we recommmend that this simple and effective management is routinely treated in patients undergoing laparoscopic cholecystectomy.

Changes in Airway Pressure, Blood Gas and Postoperative Emesis of 50% N2O in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The use of laparoscopic techniques in general surgery has gained increasing popularity. The small, limited incisions are well accepted by patients and there is the benefit of a faster recovery. But the contribution of N2O to nausea and vomiting is still controversial. This study was undertaken to evaluate the effect of N2O for airway pressure, blood gas and postoperative emesis in laparoscopic cholecystectomy. METHODS: Twenty ASA physical status I, II patients for elective laparoscopic cholecystectomy were randomly divided into two groups. First group (n=10) of patients was anesthetized with isoflurane(0.5~1.5 vol%)-O2 (2 l/min)-air (2 l/min). Second group (n=10) of patients was anesthetized with isoflurane (0.5~1.5 vol %)-O2 (2 l/min)-N2O(2 l/min). After induction of anesthesia, ventilation was controlled with tidal volume 10 ml/kg and respiratory rate 11/min and not changed throughout the operation. After measuring of control value of PaCO2, pH and airway pressures before CO2 insufflation, repeatedly measured at 20 min, 40 min after CO2 insufflation and 10 min after CO2 exsufflation. We observed the patients concerning nausea and vomiting for postoperative period. RESULTS: There were no significant intraoperative differences between the both groups with respect to PaCO2, pH and airway pressures. In the both groups, PaCO2 and airway pressure throughout the operation are significantly increased in comparison to control values. The pH is significantly decreased in comparison to control values. The incidence of postoperative nausea and vomiting was similar in both groups. CONCLUSIONS: N2O had no clinically apparent effects on airway pressure, blood gas and postoperation emesis during laparoscopic cholecystectomy.