Physiologic effects of pneumoperitoneum in adults with sickle cell disease undergoing laparoscopic cholecystectomy (A case control study)

Abstract

Background

Many studies have demonstrated the adverse consequences of pneumoperitoneum. However, few studies have examined the physiologic effects of pneumoperitoneum in adults with sickle cell disease (SCD) during laparoscopic cholecystectomy (LC).

Methods

60 ASA 1-П П patients, with cholelithiasis, scheduled for elective LC were allocated into two equal groups: group 1, normal patients without SCD (control group), and group 2, patients with SCD. The perioperative parameters of 30 SCD patients matched by age and sex to the 30 members of the non-sickler control group who underwent cholecystectomy were assessed. Study parameters (in the two groups) included heart rate (HR) per minute, mean blood pressure (MAP, mmHg), PETCO₂, and O₂ saturation (SpO₂) at the following intervals: before induction of anesthesia in the supine position (all except PETCO₂), after anesthesia and before CO₂ insufflations in the supine position, 15, 30, 45, 60 min after CO₂ insufflations in the anti-Trendelenburg position, at the end of CO₂ exsufflation in the supine position and 5 min after the end of CO₂ exsufflation in the supine position. Arterial blood gases, to measure pH, PaCO₂, and PaO₂, were determined after induction of anesthesia and before CO₂ insufflation in the supine position, then 30 min after CO₂ insufflations in the anti-Trendelenburg position, and 5 min after the end of CO₂ exsufflation in the supine position. Statistical significance was established at the p < 0.05 level.

Results

Induction of anesthesia produced a significant increase in HR in both groups. CO₂ insufflations led to an additional increase in HR and persisted till abdominal deflation. After CO₂ insufflations, MAP significantly increased from the baseline at 15, 30, 45, and 60 min, and just before deflation in the anti-Trendelenburg position. CO₂ insufflations led to a significant increase in end-tidal CO₂ (ETCO₂) in the study groups, reaching a maximum level just before abdominal deflation in the anti-Trendelenburg position. Regarding SpO₂ and PaO₂, there were insignificant changes in the two study groups throughout the procedure. In group 2, none of the patients experienced vaso-occlusive crises or other SCD- related complications.

Conclusion

This study proved the safety of LC in patients with SCD and cholelithiasis, and that they can tolerate the physiological effects of pneumoperitoneum as non-SCD adults.