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Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?

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Abstract

Background

Hypocapnia before and during carbon dioxide (CO2) insufflation for laparoscopic cholecystectomy may reduce the adverse hemodynamic responses.

Methods

After ethical approval, 100 patients scheduled for laparoscopic cholecystectomy were ventilated using a tidal volume of 8 ml/kg, an inspiration:expiration ratio of 1:2.5, and a positive end-expiratory pressure (PEEP) of 5 cm H2O. At 15 min before CO2 insufflation, the patients were randomly allocated into two groups of 50 patients each. For the normocapnia group, the respiratory rate (RR) was adjusted to maintain arterial CO2 tension (PaCO2) at 35 to 45 mmHg. For the hypocapnia group, the RR was adjusted to maintain PaCO2 at 30 to 35 mmHg. Anesthesia was maintained with sevoflurane 2% to 2.5% in 40% air oxygen and rocuronium. Hemodynamic variables, PaCO2, end-tidal CO2 tension (EtCO2), arterial-to-end-tidal CO2 (Pa-ETCO2) gradient, and RR were recorded.

Results

Compared with the control group, the use of hypocapnia before and during pneumoperitoneum was associated with significantly lower arterial blood pressures, lower PaCO2 and EtCO2 values, a higher Pa-ETCO2, a higher RR (p < 0.001), and less need for supplemental doses of fentanyl and labetalol.

Conclusion

The authors conclude that the use of hypocapnia before and during CO2 insufflation is effective in attenuating increases in blood pressure after CO2 pneumoperitoneum during anesthesia for laparoscopic cholecystectomy.

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Disclosures

Mohamed R. El-Tahan, Noha D. Al Dossary, Hatem El Emam, Douaa G. Diab, Abdulhadi Al’Saflan, Haitham Zien, Mona Al Ahmadey, and Afrah Deria have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Anaesthesia and Surgical ICU, College of Medicine, University of Dammam, The Coastal Area of Al-Rakah, Dammam, P.O. 40289, Al Khubar, 31952, Saudi Arabia

    Mohamed R. El-Tahan

  2. Department of Anaesthesia, King Abdul Aziz Airbase Hospital, Dhahran, Saudi Arabia

    Noha D. Al Dossary

  3. Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Dammam, Saudi Arabia

    Hatem El Emam, Abdulhadi Al’Saflan & Afrah Deria

  4. Mansoura University Hospitals, College of Medicine, Mansoura University, Mansoura, Egypt

    Douaa G. Diab & Mona Al Ahmadey

  5. Department of Cardiac Anaesthesia, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia

    Haitham Zien

  6. College of Medicine, Mansoura University, Mansoura, Egypt

    Mohamed R. El-Tahan

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  1. Mohamed R. El-Tahan
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  2. Noha D. Al Dossary
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  3. Hatem El Emam
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Correspondence to Mohamed R. El-Tahan.

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El-Tahan, M.R., Al Dossary, N.D., El Emam, H. et al. Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?. Surg Endosc 26, 391–397 (2012). https://doi.org/10.1007/s00464-011-1884-x

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  • DOI: https://doi.org/10.1007/s00464-011-1884-x

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