Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery

• Published in: Journal of the Chinese Medical Association 2014-07, Vol.77 (7), p.374-378
• Main Authors: Baki, Elif Dogan, Kokulu, Serdar, Bal, Ahmet, Ela, Yüksel, Sivaci, Remziye Gül, Yoldas, Murat, Çelik, Fatih, Ozturk, Nilgun Kavrut
• Format: Article
• Language: English
• Subjects: Blood Gas Analysis; Female; Humans; Internal Medicine; Laparoscopy; Male; Middle Aged; Pneumoperitoneum; positive end-expiratory pressure; Positive-Pressure Respiration; Tidal Volume - physiology
• ISSN: 1726-4901; 1728-7731
• DOI: 10.1016/j.jcma.2014.04.007

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 H2 O) or the low tidal group with PEEP group ( n  = 30, tidal volume = 6 mL/kg, rate = 18/minute, PEEP = 5 cm H2 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 (PaCO2 ) 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 PaO2 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 H2 O, p  = 0.041, low tidal; 23.67 cm H2 O, p  = 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. Conclusion The application of low tidal volume + PEEP + high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases.