Randomized trial of different intraabdominal pressures and acid-base balance alterations during laparoscopic cholecystectomy.
BACKGROUND
Experimental and clinical studies document risks of acid-base balance alterations toward acidosis and hypercapnia during intraperitoneal carbon dioxide insufflation. The aim of this study was to assess the influence of different insufflation pressures on arterial blood gas changes and acid-base alterations during laparoscopic cholecystectomy and immediately postoperatively.


METHODS
Thirty patients were randomized to receive either 10 or 15 mmHg insufflation pressure. Anesthesia was standardized for both groups. The following parameters of acid-base balance were recorded: pH, pCO2, pO2, base excess (BE), HCO3. Suitable data were analyzed by the Mann-Whitney U-test.


RESULTS
Pneumoperitoneum with carbon dioxide caused a decrease in pH toward acidosis that was either respiratory or mixed in origin. There were no statistically significant differences in acid-base balance alterations between the two groups of patients.


CONCLUSIONS
Carbon dioxide pneumoperitoneum causes alterations of the acid-base balance, mostly of respiratory or mixed type. Lowering of the insufflation pressure from 15 to 10 mmHg does not contribute to the elimination of acid-base balance alterations during laparoscopic cholecystectomy.
Sefr
R
R
Department of Surgery, Bakes Memorial Surgical Hospital, Brno, Czech Republic. sefr@mou.cz
Puszkailer
K
K
Jagos
F
F
D034841:Abdominal Cavity / Q000473:pathology / Q000502:physiology; D000137:Acid-Base Imbalance / Q000209:etiology*; D000138:Acidosis / Q000097:blood / Q000209:etiology; D002245:Carbon Dioxide / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007327:Insufflation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods; D012119:Respiration / Q000187:drug effects; D012720:Severity of Illness Index
D002245:Carbon Dioxide; D010100:Oxygen