Changes in lung and chest wall properties with abdominal insufflation of carbon dioxide are immediately reversible.
Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.
Fahy
B G
BG
Department of Anesthesiology, University of Maryland, Baltimore, USA.
Barnas
G M
GM
Nagle
S E
SE
Flowers
J L
JL
Njoku
M J
MJ
Agarwal
M
M
D000005:Abdomen; D000328:Adult; D000368:Aged; D000403:Airway Resistance; D002245:Carbon Dioxide / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic; D004548:Elasticity; D004947:Esophagus / Q000502:physiology; D005260:Female; D018662:Fundoplication; D006801:Humans; D007327:Insufflation; D010535:Laparoscopy; D008168:Lung / Q000502:physiology*; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012123:Pulmonary Ventilation; D015656:Respiratory Mechanics; D012907:Smoking / Q000503:physiopathology; D013909:Thorax / Q000502:physiology*; D013990:Tidal Volume
D002245:Carbon Dioxide