title: Does increasing end-tidal carbon dioxide during laparoscopic cholecystectomy matter?
abstract: To examine the adverse effects of peritoneal carbon dioxide (CO2) insufflation during laparoscopic cholecystectomy, both hemodynamic and respiratory alterations were continously monitored in 17 adult patients using noninvasive Doppler ultrasonography and a continuous spirometric monitoring device. During the surgery, which was performed under inhalational general anesthesia, intraabdominal pressure was maintained automatically at 10mmHg by a CO2 insufflator, and a constant minute ventilation, initially set to 30-33 mmHg of end-tidal CO2 (ETCO2), was maintained. Despite considerable depth of anesthesia, peritoneal CO2 insufflation induced a significant and immediate increase of mean blood pressure (+42%) and systemic vascular resistance (+62%), accompanied by a slight depression of cardiac index (-12%, nonsignificant), while the ETCO2 gradually increased and maximized around 30min following the initial CO2 insufflation. The stress of 10mmHg pneumoperitoneum was a major cause of hemodynamic changes during laparoscopic cholecystectomy. Some clinical strategies such as deliberate intraabdominal insufflation at the initial phase might be required to minimize these hemodynamic changes.
authors.affiliation: Department of Anesthesia, Tokyo Metropolitan Otsuka Hospital, 2-8-1 Minamiotsuka, Toshima-ku, 170, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kondoh
authors.forename: H
authors.initials: H
authors.lastname: Morisaki
authors.forename: T
authors.initials: T
authors.lastname: Yorozu
authors.forename: T
authors.initials: T
authors.lastname: Shigematsu