Randomized trial of different insufflation pressures for laparoscopic cholecystectomy.
BACKGROUND
The factors affecting cardiorespiratory changes and postoperative pain after laparoscopic cholecystectomy are poorly understood. The aim of this study was to assess these changes in patients undergoing laparoscopic cholecystectomy at an insufflation pressure of 7.5 or 15 mmHg.


METHODS
Forty patients with similar preoperative characteristics were randomized, 20 to each group.


RESULTS
There were no significant differences in intraoperative heart rate or cardiac index although the latter fell significantly soon after insufflation in both groups. The fall in cardiac index lasted longer (7 versus 2 min) and coincided with a slower rise in mean arterial pressure in those having 15 mmHg insufflation. Changes in peak airway pressure, end-tidal carbon dioxide and arterial blood gases were similar. After operation the low-pressure group had significantly less pain, better preservation of pulmonary function and were discharged home sooner (P = 0.015).


CONCLUSIONS
Insufflation pressure significantly affects the haemodynamic changes and postoperative pain associated with laparoscopic cholecystectomy.
Wallace
D H
DH
Department of Surgery, Western Infirmary, Glasgow, UK.
Serpell
M G
MG
Baxter
J N
JN
O'Dwyer
P J
PJ
D002245:Carbon Dioxide / Q000032:analysis; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume; D006339:Heart Rate; D006801:Humans; D007327:Insufflation / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D014797:Vital Capacity
D002245:Carbon Dioxide