Effect of mechanical pressure-controlled ventilation in patients with disturbed respiratory function during laparoscopic cholecystectomy

Abstract

Background/Aim: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV) and pressure controlled ventilation (PCV) during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. Methods. The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT), peak inspiratory pressure (PIP), compliance (C), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2), partial pressures of O2, CO2 (PaO2 and PaCO2) and pH of arterial blood were recorded within four time intervals. Results. There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. Conclusion. Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy.Uvod/Cilj. Danas se laparoskopska holecistektomija (LH) smatra ?zlatnim standardom? za laparoskopsku hirurgiju. Kod bolesnika sa pratecim ostecenjem respiratorne funkcije, medjutim, pneumoperitoneum i polozaj bolesnika neophodni za izvodjenje procedure LH, dovode do dodatne intraoperativne respiratorne disfunkcije koja predstavlja izazov za anesteziologa. Cilj naseg istrazivanja bio je da se utvrdi koji od dva primenjena modusa mehanicke ventilacije obezbedjuje bolje ventilatorne parametre i parametre oksigenacije tokom izvodjenja anestezije za LH kod bolesnika koji pripadaju grupi III prema American Society of Anaesthesiologists (ASA) klasifikaciji zbog pratecih respiratornih oboljenja. Metode. Ispitivanjem su obuhvacene dve grupe po 30 bolesnika podvrgnute LH. Prva grupa bila je ventilisana primenom tipa intermitentnog pozitivnog pritiska u vazdusnim putevima (grupa IPPV), a druga primenom tipa ventilacije kontrolisane pritiskom (grupa PCV). U cetiri vremenska intervala praceni su respiratorni parametri: respiratorni volumen (VT), vrsni inspiratorni pritisak (PIP), komplijansa (C), parcijalni pritisak CO2 na kraju ekspirijuma (PETCO2), saturacija arterijske krvi kiseonikom (SpO2), parcijalni pritisci kiseonika i ugljen-dioksida u arterijskoj krvi (PaO2 i PaCO2) i pH arterijske krvi. Rezultati. Nalazi VT, SpO2, PaO2, Pa-CO2 i pH nisu se statisticki znacajno razlikovali ni unutar, ni izmedju grupa. U vremenskom intervalu t1 nije bilo statisticki znacajne razlike u vrednostima PIP, C, PETCO2 izmedju IPPV i PCV grupe. U sledeca tri vremenska intervala bilo je statisticki znacajne do visokoznacajne razlike u vrednostima ova tri respiratorna parametra izmedju dve ispitivane grupe: PIP je bio manji, a C i PETCO2 bili su veci u PCV grupi. Zakljucak. Mehanicka ventilacija tipa PCV obezbedjuje bolje intraoperativne parametre ventilacije tokom izvodjenja LH kod bolesnika koji pripadaju grupi III prema ASA klasifikaciji zbog pratecih respiratornih oboljenja.