Lactate and acid base changes during laparoscopic cholecystectomy.
BACKGROUND
The observation of hemodynamic and metabolic impairment related to CO2 pneumoperitoneum and postoperative mesenteric ischemia reports following laparoscopic procedures have raised concern about local and systemic effects of increase intraabdominal pressure during laparoscopic procedures. The present study aims to evaluate the metabolic and acid base responses of using high pressure versus low pressure pneumoperitonium in patients undergoing laparoscopic cholecystectomy in a prospective randomized clinical trial.


METHODS
20 ASA I-II patients scheduled for elective laparoscopic cholecystectomy were randomly allocated to one of two study groups; high pressure pneumoperitoneum 12-14mmHg (HPP, n=10) versus low pressure pneumoperitoneum 6-8mmHg (LPP, n=10) undergoing laparoscopic cholecystectomy. Arterial blood gases and lactate levels were determined after induction of anesthesia (before pneumoperitonium), then after 10 min, then 30 min after insufflations and at the end of surgery and 1 hour postoperatively. Nurses in recovery unit reported pain assessment starting postoperatively until 3 hours on a 10mm VAS (0-10). Statistical significant was established at P<0.05.


RESULTS
Bicarbonate was significantly (P>0.0412) lower in high pressure group at 30 min and 60 min after insufflations. In high pressure group lactate levels increased significantly as compared to low pressure group, (at 30 minutes after the establishment of abdominal pneumatic inflation P<0.006 and remained significantly increased (P<0.001) until the end of surgery and one hour thereafter) (P<0.001). The mean postoperative pain score during second hour (VAS) at HPP group was 7.4 +/- 1.17 which is significantly (P < or = 0.006) higher than pain score in LPP group 5.0 +/- 1.886. Shoulder tip pain was reported in 3 patients in the high pressure group and only one patient in the lower pressure group.


CONCLUSIONS
High-pressure pneumoperitonium causes statistically significant elevation in the arterial lactate level intraoperatively until one hour post operatively. It also causes higher pain score and shoulder tip pain.
Ibraheim
Osama A
OA
Department of Anesthesia, King Kahlid University Hospital, King Saud University, Riyadh, Saudia Arabia. osamaibraheim@yahoo.com
Samarkandi
Abdulhamid H
AH
Alshehry
Hassan
H
Faden
Awatif
A
Farouk
Eltinay Omar
EO
D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D020069:Shoulder Pain / Q000209:etiology
D001639:Bicarbonates; D002245:Carbon Dioxide; D019344:Lactic Acid