The difference between intramural and arterial partial pressure of carbon dioxide increases significantly during laparoscopic cholecystectomy: the effect of thoracic epidural anesthesia.
We studied the effects of pneumoperitoneum on gastric submucosal perfusion metabolism during elective laparoscopic cholecystectomy (LASC) by measuring the PCO(2) gap, defined as the difference between intramucosal PCO(2) and arterial PCO(2), using gas tonometry in 20 patients. Furthermore, we examined whether thoracic epidural anesthesia (TEA) affects gastric submucosal perfusion metabolism during LASC. Patients were randomly allocated to receive general anesthesia (group G, n = 10) or general anesthesia combined with TEA (group E, n = 10). In both groups, the PCO(2) gap increased significantly during pneumoperitoneum and remained at this level until the end of surgery compared with the baseline value. There were no significant differences in PCO(2) gap values between the two groups at any time sampled. These results suggested that pneumoperitoneum significantly impaired gastric submucosal perfusion and metabolism and that TEA did not attenuate the impairment of gastric submucosal perfusion during or after pneumoperitoneum.


CONCLUSIONS
We investigated the effect of pneumoperitoneum on gastric submucosal perfusion by measuring PCO(2) gap with the use of gas tonometry. PCO(2) gap significantly increased during and after the pneumoperitoneum compared with the control level. Thoracic epidural anesthesia did not attenuate this inhibition.
Nandate
Koichiroh
K
Departments of *Anesthesiology and †First Surgery, University of Occupational and Environmental Health, Japan.
Ogata
Masanori
M
Nishimura
Masahiro
M
Katsuki
Takefumi
T
Kusuda
Shinichi
S
Okamoto
Kohji
K
Nagata
Naoki
N
Shigematsu
Akio
A
D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D001639:Bicarbonates / Q000097:blood; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology
D001639:Bicarbonates; D002245:Carbon Dioxide