Korean J Anesthesiol.  2012 Nov;63(5):419-424. 10.4097/kjae.2012.63.5.419.

Effects of pneumoperitoneal pressure and position changes on respiratory mechanics during laparoscopic colectomy

• Park JS
• Ahn EJ
• Ko DD
• Kang H
• Shin HY
• Baek CH
• Jung YH
• Woo YC
• Kim JY
• Koo GH

• KMID: 1767209
• DOI: http://doi.org/10.4097/kjae.2012.63.5.419

Abstract

BACKGROUND
This study was designed to assess the effects of pneumoperitoneal pressure (PP) and positional changes on the respiratory mechanics during laparoscopy assisted colectomy.
METHODS
Peak inspiratory pressure, plateau pressure, lung compliance, and airway resistance were recorded in PP of 10 mmHg and 15 mmHg, with the position change in 5 steps: head-down at 20degrees, head-down at 10degrees, neutral position, head-up at 10degrees and head-up at 20degrees.
RESULTS
When the patient was placed head-down, the position change accentuated the effects of pneumoperitoneum on respiratory mechanics. However, when the patient was placed in a head-up position during pneumoperitoneum the results showed no pattern. In the 20degrees head-up position with the PP being 10 mmHg, the compliance increased from 30.6 to 32.6 ml/cmH2O compared with neutral position (P = 0.002). However with the PP being 15 mmHg, the compliance had not changed compared with neutral position (P = 0.989). In 20degrees head-down position with the PP of 10 mmHg, the compliance was measured as 24.2 ml/cmH2O. This was higher than that for patients in the 10degrees head-down position with a PP of 15 mmHg, which was recorded as 21.2 ml/cmH2O. Also in the airway resistance, the patient in the 20degrees head-down position with the PP of 10 mmHg showed 15.8 cmH2O/L/sec, while the patient in the 10degrees head-down position with the PP of 15 mmHg showed 16.2 cmH2O/L/sec of airway resistance. These results were not statistically significant but still suggested that the head-down position accentuated the effects of pneumoperitoneum on respiratory mechanics.
CONCLUSIONS
Our results suggest that respiratory mechanics are affected by the patient position and the level of PP - the latter having greater effect.

Keyword

Laparocolectomy; Pneumoperitoneum; Position; Respiratory mechanics

MeSH Terms

Airway Resistance
Colectomy
Compliance
Humans
Laparoscopy
Lung Compliance
Pneumoperitoneum
Respiratory Mechanics