title: [Respiratory mechanics and gas exchange in anesthesia for laparoscopic cholecystectomy].
abstract: OBJECTIVE
  To evaluate the influence of endoabdominal CO2 insufflation during anaesthesia for laparoscopic cholecystectomy on airway pressure, gas exchange and their relationships.
  
  
  METHODS
  Perspective; clinical investigation.
  
  
  METHODS
  Operating room at a central general hospital.
  
  
  METHODS
  14 patients (3 males and 11 females) ASA 1-2, non smokers, without lung disease, scheduled for elective laparoscopic cholecystectomy.
  
  
  METHODS
  During balanced anaesthesia (N2O/O2, Fentanyl, Isoflurane), with fixed minute ventilation, endoperitoneal insufflation of CO2 held at constant pressure (21 cm H2O).
  
  
  METHODS
  Serial measurements of: Airway pressure, near-static compliance, ETCO2, CO2 minute production, blood gas analysis and derived data: P(a-A)O2, P(a-ET)CO2, Vd/Vt.
  
  
  RESULTS
  During insufflation peak and pause pressures increased by 6 cm H2O and mean pressure; by 3 cm H2O; Compliance was reduced by 48%; PaO2 decreased evenly with time (p > 0.05) irrespective of the airway pressure. PaCO2, PECO2, VCO2 and Vd/Vt after a sharp increase stabilized at 30% (mean value) over the baseline. P(a-ET)CO2 and Vd/Vt fluctuate in the physiological range except for two short but significant changes (p > 0.05) at insufflation and desufflation time.
  
  
  CONCLUSIONS
  Laparoscopic technique for cholecystectomy, at least in healthy patients, produces relevant changes in airway pressures but only minor modifications of gas exchange, similar to those seen during general anaesthesia. This technique can be safely used for routine operation with standard monitoring equipment.
authors.affiliation: UO di Anestesia e Rianimazione, USL10/A, Ospedale di S. M. Nuova, Firenze.
authors.forename: N
authors.initials: N
authors.lastname: Di Sebastiano
authors.forename: L
authors.initials: L
authors.lastname: Bonetti
authors.forename: P
authors.initials: P
authors.lastname: Boninsegni
authors.forename: A
authors.initials: A
authors.lastname: Di Filippo
authors.forename: E
authors.initials: E
authors.lastname: Peruzzi
authors.forename: L
authors.initials: L
authors.lastname: Arena
mesh_terms: D000328:Adult; D000758:Anesthesia; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D015656:Respiratory Mechanics
vernacular_title: Meccanica respiratoria e scambio dei gas nella anestesia per colecistectomia per via laparoscopica.