title: Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery.
abstract: BACKGROUND
  Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery.
  
  
  METHODS
  A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group (n = 30, tidal volume = 10 mL/kg, rate = 12/minute, PEEP = 0 cm H(2)O) or the low tidal group with PEEP group (n = 30, tidal volume = 6 mL/kg, rate = 18/minute, PEEP = 5 cm H(2)O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP.
  
  
  RESULTS
  There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO(2)) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg;p = 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO(2) values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H(2)O, p = 0.041, low tidal; 23.67 cm H(2)O, p = 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions.
  
  
  CONCLUSIONS
  The application of low tidal volume + PEEP + high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases.
authors.affiliation: Department of Anesthesiology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey. Electronic address: elifbaki1973@mynet.com.
authors.forename: Elif Dogan
authors.initials: ED
authors.lastname: Baki
authors.affiliation: Department of Anesthesiology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Kokulu
authors.affiliation: Department of General Surgery, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bal
authors.affiliation: Department of Anesthesiology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Ela
authors.affiliation: Department of Anesthesiology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
authors.forename: Remziye Gül
authors.initials: RG
authors.lastname: Sivaci
authors.affiliation: Department of Anesthesiology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Yoldas
authors.affiliation: Department of Obstetrics and Gynecology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Çelik
authors.affiliation: Anesthesiology Clinic, Antalya Training and Research Hospital, Antalya, Turkey.
authors.forename: Nilgun Kavrut
authors.initials: NK
authors.lastname: Ozturk
mesh_terms: D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum; D011175:Positive-Pressure Respiration; D013990:Tidal Volume / Q000502:physiology*
keywords: laparoscopy; pneumoperitoneum; positive end-expiratory pressure