title: Minimal impairment in pulmonary function following laparoscopic surgery.
abstract: BACKGROUND
  Pulmonary function may be impaired in connection with laparoscopic surgery, especially in the head-down body position, but the clinical importance has not been assessed in detail. The aim of this study was to assess pulmonary function after laparoscopic hysterectomy and laparoscopic cholecystectomy. We hypothesised that arterial oxygenation would be more impaired after hysterectomy performed in the head-down position than after cholecystectomy in the head-up position.
  
  
  METHODS
  We included 60 women in this prospective, observational study. The patients underwent elective laparoscopic cholecystectomy in the 20° head-up position or hysterectomy in the 30° head-down position. The primary outcome was the difference between arterial oxygenation (PaO2 ) 2 h postoperatively and the preoperative value. Two hours and 24 h after surgery, pulmonary shunt and ventilation-perfusion mismatch were assessed by use of an automatic lung parameter estimation system.
  
  
  RESULTS
  Two hours after surgery, the mean change from baseline in PaO2 was -0.65 kPa [95% confidence interval (CI) -3.5 to 3.4, P = 0.14] in the hysterectomy group and -0.22 kPa [95% CI -3.4 to 2.0, P = 0.12] in the cholecystectomy group (P = 0.88). Shunt was significantly greater in the cholecystectomy group 24 h after surgery compared to the hysterectomy group [4%, 95% CI 0 to 9 vs. 0%, 95% CI 0 to 7, P = 0.02].
  
  
  CONCLUSIONS
  Minimal impairment in pulmonary gas exchange was found after laparoscopic surgery. Pulmonary shunt was larger after laparoscopic cholecystectomy, but no clinically significant differences in postoperative pulmonary gas exchange or spirometry were found between laparoscopic hysterectomy and laparoscopic cholecystectomy.
authors.affiliation: Department of Anaesthesiology, University of Copenhagen, Herlev Hospital, Herlev, Denmark.
authors.forename: A K
authors.initials: AK
authors.lastname: Staehr-Rye
authors.forename: L S
authors.initials: LS
authors.lastname: Rasmussen
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.forename: C
authors.initials: C
authors.lastname: Steen-Hansen
authors.forename: T F
authors.initials: TF
authors.lastname: Nielsen
authors.forename: C V
authors.initials: CV
authors.lastname: Rosenstock
authors.forename: H V
authors.initials: HV
authors.lastname: Clausen
authors.forename: M K
authors.initials: MK
authors.lastname: Sørensen
authors.forename: J
authors.initials: J
authors.lastname: VON H Regeur
authors.forename: M R
authors.initials: MR
authors.lastname: Gätke
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000009:adverse effects*; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology*; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D056888:Patient Positioning; D011183:Postoperative Complications / Q000503:physiopathology*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013147:Spirometry; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D010100:Oxygen