Cardiovascular and Ventilatory Changes during Laparoscopic Cholecystectomy under General Anesthesia / 대한마취과학회지

ABSTRACT

Peritonesl insufflation of CO2 to creste the pneumoperitoneum necessary far laparoscopy in- duces intraoperative cardiovascular and ventilatory changes that complicste anesthetic management of laparoscopy. We investigated cardiovascular and ventilstory changes during laparoscopic cholecystectomy under general anesthesia in 11 healthy patients. During operation, intraabdominal pressure was maintained automatically at 14 mmHg by a CO2 insufflator and controlled ventilation setting was adjusted at the values of PaCO2 about 30 mmHg before peritoneal insufflation, and this ventilatory setting was not changed throughout the operation. We measured peak inspiratory pressure(Ppi), mean arterial pressure(MAP), pulse rate(PR), arterial blood gas and end tidal carbon dioxide(PEtCO2) before and during peritoneal insufflation, snd after peritoneal exsufflation. Peritoneal insufflation of CO2 resulted in a significant increase of Ppi, MAP, PaCO2 and PEtCO2, a significant decrease of pH. And PaCO2 and pH were not restored until 15 minutes after CO2 exsufflation. PR and PaO2 were not changed significantly throughout the operation. Conclusively, during general anesthesia for laparoscopic choleeystectomy, hyperventilation was needed under the monitoring of PEtCO2 or PEt,CO2 and special care and monitoring was mendatory for the patients with impaired cardiopulmonary function and increased intracranial pressure.