Pneumoperitoneum evaluation the effects of respiratory dynamics, hemodynamic parameters and surgical satisfaction in the laparoscopic cholecystectomy

Abstract Aim: Inspiratory, hemodynamic and metabolic changes occur in laparoscopic surgery depending on pneumoperitoneum and patient positions. Another advantage of pneumoperitoneum is to provide sufficient surgical vision. This study aims to evaluate the effects of intraabdominal pressure increase based CO2 pneumoperitoneum in laparoscopic operations on the hemodynamic parameters and respiratory dynamics in the satisfaction of surgeon and operative view. Materials and methods: This study was included with the 123 patients between 18-70 age, ASA I-III class prospectively and totally 104 patients' data were analysed, the patients were divided into two groups as the group Low Pressure (< 12mmHg) (LP) (n=53) and the group Standart Pressure (> 13mmHg) (SP) (n=51). All the patients in the LP and SP groups were applied standart and TOF monitorization. Each group were administered anaesthesia induction every other two minutes and after 0,2-0,5 mcg/kg/min remifentanil infusion intravenous (IV) 1-2 mg/kg propofol and IV 0,5 mg/kg rocuronium. When maintenance of anaesthesia is with the %50 O2/ air mixing, 0,1-0,4 mcg/kg/min remifentanil and 50-150 mcg/kg/min (3-9 mg/kg/h) propofol IV infusions and TOF >1 twitch replies during the surgical operation 0,1-0,15 mg/kg neuromuscular blocking agent was provided with the rocuronium. If the return on the neuromuscular block reach to the score 1-2 post tetanic counting (PTC), 4.0 mg/kg was given. Before, during and after the peritoneal insufflation the peroperative ventilation parameters (peak airway pressure, mean airway pressure and end tidal carbon dioxide, tidal volume, minute ventilation volume) and hemodynamics parameters (systolic, diastolic and mean arterial blood pressure and heart rate) were recorded. The adequacy of the pneumoperitoneum (adequate / inadequate), gastric distention (VAS scale) and the operative view as graded (1-poor to 4-excellent) by the operating surgeon were also recorded. Results: In this study, the peripheral oxygen saturation indicate a significant difference between the low and standart pressure pneumoperitoneum in view of tidal volume, respiratory rate, end tidal CO2, mean and peak inspiratory pressure, minute ventilation values (p> 0.05). In terms of hemodynamic, when compared just after the intubation and before extubation values, it was observed that in LP group systolic, diastolic and mean blood pressure values were higher (p<0.05). It was not found a significant difference between the two groups when these values were observed after insufflation and before desufflation (p > 0.05). In terms of heart rate, it was not observed a significant difference in determined periods between groups (p > 0.05). It was not found a significant difference between the groups in terms of surgical satisfaction and vision (p > 0.05). Conclusion: The low pressure pneumoperitoneum provides effective respiratory mechanics and a stabil hemodynamic in laparoscopic cholecystectomy. Besides, it provides to the surgeon a sufficient place for his hand manipulations. As anaesthetic method, TIVA and neuromuscular blockage provided a good surgery vision in low pressure pneumoperitoneum. Key Words: Laparoscopic cholecystectomy, pneumoperitoneum, surgical vision, surgery satisfaction, low pressure and deep neuromuscular blokage.