title: Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?
abstract: BACKGROUND
  Hypocapnia before and during carbon dioxide (CO(2)) insufflation for laparoscopic cholecystectomy may reduce the adverse hemodynamic responses.
  
  
  METHODS
  After ethical approval, 100 patients scheduled for laparoscopic cholecystectomy were ventilated using a tidal volume of 8 ml/kg, an inspiration:expiration ratio of 1:2.5, and a positive end-expiratory pressure (PEEP) of 5 cm H(2)O. At 15 min before CO(2) insufflation, the patients were randomly allocated into two groups of 50 patients each. For the normocapnia group, the respiratory rate (RR) was adjusted to maintain arterial CO(2) tension (PaCO(2)) at 35 to 45 mmHg. For the hypocapnia group, the RR was adjusted to maintain PaCO(2) at 30 to 35 mmHg. Anesthesia was maintained with sevoflurane 2% to 2.5% in 40% air oxygen and rocuronium. Hemodynamic variables, PaCO(2), end-tidal CO(2) tension (EtCO(2)), arterial-to-end-tidal CO(2) (Pa-ETCO(2)) gradient, and RR were recorded.
  
  
  RESULTS
  Compared with the control group, the use of hypocapnia before and during pneumoperitoneum was associated with significantly lower arterial blood pressures, lower PaCO(2) and EtCO(2) values, a higher Pa-ETCO(2), a higher RR (p < 0.001), and less need for supplemental doses of fentanyl and labetalol.
  
  
  CONCLUSIONS
  The authors conclude that the use of hypocapnia before and during CO(2) insufflation is effective in attenuating increases in blood pressure after CO(2) pneumoperitoneum during anesthesia for laparoscopic cholecystectomy.
authors: Department of Anaesthesia and Surgical ICU, College of Medicine, University of Dammam, The Coastal Area of Al-Rakah, Dammam, P.O. 40289, Al Khubar, 31952, Saudi Arabia. mohamedrefaateltahan@yahoo.com
authors: Mohamed R
authors: MR
authors: El-Tahan
authors: Noha D
authors: ND
authors: Al Dossary
authors: Hatem
authors: H
authors: El Emam
authors: Douaa G
authors: DG
authors: Diab
authors: Abdulhadi
authors: A
authors: Al'Saflan
authors: Haitham
authors: H
authors: Zien
authors: Mona
authors: M
authors: Al Ahmadey
authors: Afrah
authors: A
authors: Deria
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D010313:Partial Pressure; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D056152:Respiratory Rate / Q000502:physiology
chemical_list: D002245:Carbon Dioxide