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Changes in respiratory compliance at laparoscopy: measurements using side stream spirometry

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Abstract

In order to quantify changes in total respiratory compliance (Crs) effected by peritoneal pressurization we measured, under standardized anaesthetic conditions and using side stream spirometry Crs in 32 patients scheduled for abdominal surgery through laparoscopic techniques. To qualify the changes in Crs as to the type (duration and patient’s position) of surgery, 20 patients having cholecystectomy, eight having gastric fundoplication, and four having inguinal hernia repair were studied. At CO2 insufflation to a mean intraabdominal pressure of 11 cmH2O in the horizontal position, Crs decreased abruptly by 20% in each of the surgical sub-groups (P < 0.05–0.01). During the insufflation period a further deterioration was observed, most pronounced in inguinal hernia patients operated upon in a head-down tilt position (P < 0.05). In the cholecystectomy and fundoplication patients, operated upon in a head-up tilt, the recovery of Crs was immediate at deflation, whereas an incomplete recovery (P < 0.05 vs initial values) was seen in the hernia patients. In evaluating all patients none of the demographic factors, age, sex, body-mass-index, intraabdominal pressure, or duration of pressurization, were associated with the detected changes.

Résumé

Dans le but de quantifier les changements de compliance pulmonaire totale (Crs provoqués par la mise sous tension intra-péritonéale, nous avons mesuré par spirométrie et sous des conditions d’anesthésie standardisées, la Crs auprès de 32 patients soumis à une chirurgie abdominale par laparoscopie. Les changements de Crs ont été évalués selon les caractéristiques de l’intervention (la durée de l’intervention et la position du sujet): 20 patients subissaient une cholécystectomie, huit une fondoplicature gastrique et quatre une cure de hernie inguinale. En position horizontale, lorsque la pression d’insufflation du CO2 atteint 11 cm H2O en moyenne, la Crs baisse subitement de 20% dans chacun des sous-groupes (P < 0,05–0,01). Pendant la période d’insufflation, la détérioration s’accentue, surtout chez les opérés pour cure de hernie inguinale en position déclive (P < 0,05). Chez les patients soumis à une cholécystectomie ou une fondoplicature en position proclive, le retour à la normale est immédiat dès la déflation, alors qu’il est incomplet (P < 0,05 vs la valeur de base) chez les opérés pour hernie inguinale. Dans l’ensemble, aucun des facteurs démographiques, ni l’âge, le sexe, le poids, l’index de masse corporelle, la pression intra-abdominale, et sa durée, ne sont associés aux changements décelés.

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Correspondence to Markku Oikkonen.

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Oikkonen, M., Tallgren, M. Changes in respiratory compliance at laparoscopy: measurements using side stream spirometry. Can J Anaesth 42, 495 (1995). https://doi.org/10.1007/BF03011687

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Key words

  • measurement techniques: side stream spirometry, compliance
  • lung: compliance, volume
  • surgery: laparoscopy