[Effect of mechanical pressure-controled ventilation in patients with disturbed respiratory function during laparoscopic cholecystectomy].

BACKGROUND/AIM: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV) and pressure controlled ventilation (PCV) during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. METHODS: The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT), peak inspiratory pressure (PIP), compliance (C), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2), partial pressures of O2, CO2 (PaO2 and PaCO2) and pH of arterial blood were recorded within four time intervals. RESULTS: There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. CONCLUSION: Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy.

[Hemodynamic stability in total intravenous propofol anesthesia with midazolam coinduction versus general balanced anaesthesia in laparoscopic cholecystectomy].

BACKGROUND/AIM: Laparoscopic cholecystectomy can be a greater challenge for anesthesiologist than for surgeon if the patient is ASA III with concomitant cardiovascular diseases. The aim of our study was to compare the effect of total intravenous anesthesia (TIVA--propofol with midazolam) and general balanced anesthesia (GBA--midazolam, thiopenton, nitrous oxide and 02) on hemodynamic stability in the ASA III patients who underwent laparoscopic cholecystectomy. METHODS: In our study, 60 patients were randomized into two groups depending on whether they received TIVA or GBA. Heart rate, systolic, diastolic and mean arterial pressure were monitored continuously and recorded in five time intervals. RESULTS: Statistical analysis showed that TIVA with propofol provides better hemodynamic stability (less than 10% deviation from basal values for each measured parameter) then GBA group (p < 0.01). CONCLUSION: Total intravenous anesthesia with propofol provides better hemodynamic stability for ASA III patients with concomitant cardiovascular diseases then GBA.