A Study on the Effect of CO2 Pneumoperitoneum and Position Changes on Hemodynamic and Respiratory Parameters in Gynecologic Laparoscopic Surgery

Na, J H; Kim, J H; Park, S E; Lee, E J; Cho, S K; Kim, Y M; Kim, Y T; Nam, C H; Mok, J E

Abstract

OBJECTIVE
The purpose of this study was to identify the hemodynamic and respiratory responses in patients undergoing gynecological laparoscopic operations according to the change of position and induction of pnemoperitoneum (PP).
METHODS
Ten patients without cardiopulmonary disease undergoing various laparoscopic pelvic surgeries were analyzed in terms of cardiopulmonary parameters such as invasive arterial blood pressure (BP), heart rate (HR), central venous pressure (CVP), endexpiratory pCO2, pH, pCO2, and HCO3-. Under the standardized setting of general anesthesia and laparoscopy, cardiopulmonary parameters were determined in a supine position (baseline) and a supine lithotomy position, Trendelenburg lithotomy position, each with and without PP at predetermined set points.
RESULTS
Arterial BP increased significantly after CO2 insufflation and these increased values persisted throughout the operation and even after 10 minutes after desufflation in supine position. HR`s and HCO3- concentrations were quite stable during anesthesia irrespective of PP and position. CVP was elevated both by Trendelenburg position and PP. The significant elevation of pECO2 began with PP in Trendelenburg position and PIP began to elevate after PP in supine position. These two parameters were recovered immediately to the baseline level after desufflation in supine position. Aterial blood pH began to decrease with PP in Trendelenburg position, and lowered level persisted after desufflation in supine position. The pCO2 level was elevated significantly only when the duration of PP was 40 minutes or more.
CONCLUSION
Although some hemodynamic (BP, CVP) and pulmonary (pCO2, pH, CO2) parameters are changed during laparoscopic surgery, these are within normal range in healthy patients. Most of these changes seems to affected not by position change, but by pneumoperitoneum.