Changes in end-tidal carbon dioxide during gynecologic laparoscopy: spontaneous versus controlled ventilation.
OBJECTIVE
To study the changes in PETCO2 during spontaneous and controlled ventilation in patients undergoing gynecologic laparoscopy.


METHODS
Randomized, unblinded study.


METHODS
Department of Gynecology, University Hospital, Linköping, Sweden; Central Hospital, Norrköping, Sweden.


METHODS
Forty healthy patients undergoing gynecologic laparoscopy.


METHODS
Patients were divided into 4 groups: Group 1 breathed spontaneously via an endotracheal tube, while the other three groups underwent controlled ventilation to an initial PETCO2 of 3 kPa (22 mmHg) (Group 2), 4 kPa (30 mmHg) (Group 3), or 5 kPa (37 mmHg) (Group 4).


RESULTS
PETCO2 levels were measured at fixed time intervals. Arterial blood gas analyses were done to compare the difference between PETCO2 and PaCO2. In Group 1, PETCO2 increased soon after insufflation and remained above 6 kPa (44 mmHg) throughout the procedure. In Groups 2, 3, and 4, PETCO2 also rose after insufflation, and an initial PETCO2 of 4 kPa (30 mmHg) was ideal, as all PETCO2 values were less than 5.5 kPa (41 mmHg). Occasional episodes of arrhythmia were seen in Group 1. However, no major adverse effects were observed in any of the groups.


CONCLUSIONS
In view of the high PETCO2 levels, spontaneous breathing should be avoided during gynecologic laparoscopy, and ventilation to an initial PETCO2 of 4 kPa (30 mmHg) is recommended during controlled ventilation.
Vegfors
M
M
Department of Anesthesiology, University Hospital, Linköping, Sweden.
Engborg
L
L
Gupta
A
A
Lennmarken
C
C
D000328:Adult; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000032:analysis* / Q000097:blood; D005117:Cardiac Complexes, Premature / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005836:Genitalia, Female / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007327:Insufflation; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000008:administration & dosage; D010535:Laparoscopy / Q000379:methods; D008991:Monitoring, Physiologic; D009609:Nitrous Oxide / Q000008:administration & dosage; D012119:Respiration / Q000502:physiology*; D012121:Respiration, Artificial; D013990:Tidal Volume
D002245:Carbon Dioxide; D007530:Isoflurane; D009609:Nitrous Oxide; D005283:Fentanyl