The evaluation of pulmoner function and blood gases in laparoscopic and open nephrectomies under general anaesthesia with isoflurane and remifentanil

The evaluation of pulmoner function and blood gases in laparoscopic and open nephrectomies under general anaesthesia with isoflurane and remifentanilThe aim of this study was to assess the early postoperative lung functions and arteriel blood gases and to show any superiority for open or laparoscopic nephrectomies, the gold standard treatment of renal cell carsinoma under general anesthesia with isoflurane and remifentanil.Fourty ASA I or II class patients scheduled for nephrectomy either laparoscopic (n=20) or open surgery (n=20) were included in this study. Pulmonary fuction tests (FEV1, FVK, FEF25, FEF50, FEF25-75, FIV1 and PEF) were performed and the arteriel blood gases (pH, PaCO2, PaO2, SaO2 and BE) during breathing room air were analized in each group one day before the operation. To reduce the effects on pulmonary function, standard anesthesia, ventilation and postoperative analgesia were administered. Perioperatively, the hemodynamic parameters and blood gases analysis were noted. When the patients were transferred from operating room to the recovery room, the blood gases was analized during breathing room air at the end of the 1 hour in the recovery room. The postoperative pain was assessed according to VAS during 24 hour postoperatively. The patients were discharged after arteriel blood gases and pulmonary function tests were performed postoperative 24 hour.All spirometric variables decreased after both open and laparoscopic nephrectomy on the postoperative 24.hour. In addition FEV1, FVK, FEF25 ve FEF25-75 values decreased by 39.7 %, 37.4 %, 27.7 %, 51.8 % in the open surgery group and it was significantly less than laparoscopic surgery (29.9%, 32.5%, 23.2%, 44.5%). The SaO2 and PaO2 values were also decreased on postoperative 1 day in both groups, pH decreased, PaCO2 increased at the postoperative 1 hour but it returned to preoperative values at postoperative 24.hour in both groups.We concluded that the early postoperative pulmonary functions less impaired in the laparoscopic nephrectomy group than in the open nephrectomy, but the effects on arteriel blood gases were smilar in both groups and no clinically relevant differences were found. Under the light of these findings, we thought that the laparoscopic nephrectomy was more superior than open nephrectomy considering pulmonary functions.Key words: laparoscopic nephrectomy, open nephrectomy, pulmonary function tests