Effect of Pneumoperitoneum on Functional Residual Capacity

  • Akira Matsunaga
  • Katsuhiro Ohse
  • Yasuyuki Kakihana
  • Mina Masuda
  • Kanako Ikoma
  • Yuichi Kanmura
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (volume 737)



Pneumoperitoneum (PP) during laparoscopic surgery of the abdomen induces a mechanical compression of the diaphragm that reduces the functional residual capacity (FRC). The aim of this study was to evaluate the adverse effect of PP on FRC and the improvement of the degraded FRC using positive end-expiratory pressure (PEEP).


Sixteen patients with normal pulmonary and cardiac functions underwent FRC measurements using an Engström Carestation ventilator with a built-in modified nitrogen washout/washin technique (GE Healthcare). Arterial blood gas analyzes were performed before PP, during PP, and during PP with a PEEP of 5 cmH2O. All patients were anesthetized with propofol and remifentanil and were mechanically ventilated with a tidal volume of 8 mL/kg, a frequency of 10–14 cycles/min, and an FiO2 of 40% using an Engström Carestation. PP increased the intra-abdominal pressure (IAP) to 9 mmHg.


The Engström Carestation easily measured the FRC in patients receiving mechanical ventilation at bedside. PP significantly (p < 0.05) decreased the FRC and PaO2 from 1,833 (1,300–2,112) mL to 1,573 (1,302–2,022) mL and from 173 (155–191) mmHg to 151 (135–165) mmHg, respectively. In contrast, a PEEP of 5 cmH2O significantly (p < 0.05) increased the FRC and PaO2 to 1,861 (1,578–2,273) mL and 165 (137–170) mmHg, respectively.


PP decreased the FRC, which was improved by PEEP. The reduction in the FRC and the decrease in arterial oxygenation were not correlated.


Chronic Obstructive Pulmonary Disease Arterial Oxygenation Functional Residual Capacity Peak Inspiratory Pressure Closing Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Andersson LE, Bååth M, Thörne A et al (2005) Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomography. Anesthesiology 102:293–299PubMedCrossRefGoogle Scholar
  2. 2.
    Chiumello D, Cressoni M, Chierichetti M et al (2008) Nitrogen washout/washin, helium dilution and computed tomography in the assessment of end expiratory lung volume. Crit Care 12:R150PubMedCrossRefGoogle Scholar
  3. 3.
    Olegård C, Söndergaard S, Houltz E et al (2005) Estimation of functional residual capacity at the bedside using standard monitoring equipment: a modified nitrogen washout/washin technique requiring a small change of the inspired oxygen fraction. Anesth Analg 101:206–212PubMedCrossRefGoogle Scholar
  4. 4.
    Hedenstierna G, Strandberg A, Brismar B et al (1985) Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology 62:247–254PubMedCrossRefGoogle Scholar
  5. 5.
    Hedenstierna G, Tokics L, Strandberg A et al (1986) Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis. Acta Anaesthesiol Scand 30:183–191PubMedCrossRefGoogle Scholar
  6. 6.
    Tokics L, Hedenstierna G, Strandberg A et al (1987) Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure. Anesthesiology 66:157–167PubMedCrossRefGoogle Scholar
  7. 7.
    Neumann P, Zinserling J, Haase C et al (1998) Evaluation of respiratory inductive plethysmography in controlled ventilation: measurement of tidal volume and PEEP-induced changes of end-expiratory lung volume. Chest 113:443–451PubMedCrossRefGoogle Scholar
  8. 8.
    Odeberg S, Sollevi A (1995) Pneumoperitoneum for laparoscopic surgery does not increase venous admixture. Eur J Anaesthesiol 12:541–548PubMedGoogle Scholar
  9. 9.
    Strang CM, Hachenberg T, Fredén F et al (2009) Development of atelectasis and arterial to end-tidal PCO2-difference in a porcine model of pneumoperitoneum. Br J Anaesth 103:298–303PubMedCrossRefGoogle Scholar
  10. 10.
    Nishio I, Noguchi J, Konishi M et al (1993) The effects of anesthetic techniques and insufflating gases on ventilation during laparoscopy. Masui 42:862–866PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Akira Matsunaga
    • 1
  • Katsuhiro Ohse
    • 1
  • Yasuyuki Kakihana
    • 1
  • Mina Masuda
    • 1
  • Kanako Ikoma
    • 1
  • Yuichi Kanmura
    • 1
  1. 1.Department of Anesthesiology & Critical Care Medicine, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan

Personalised recommendations