THE EFFECT OF PNEUMOPERITONEUM ON RESPIRATORY MECHANICS UNDER GENERAL ANESTHESIA DURING GYNECOLOGICAL LAPAROSCOPIC SURGERY / Шинэ санаа Шинэ нээлт

ABSTRACT

Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO2 gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of Pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH2O, then after T10, T20, T30 minutes in the 20°Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated.During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure (7 cmH2O), plateau pressure(6 cmH2O), and end-tidal CO2 (6 mmH2O) while dynamic lung compliance decreased by 11 ml/cmH2O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes.The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO2 significantly increased after pneumoperitoneum and CO2 deflation. Anesthesiologists must be aware of changes in respiratory dynamics and must be ready to respond promptly and adequately according to pneumoperitoneum with Tredelenburg position during laparoscopic surgery.