Peritoneal insufflation of CO2 to create the pneumoperitoneum necessary for laparoscopy induces intraoperative cardiovascular and ventilatory changes that complicate anesthetic management of laparoscopy. We investigated cardiovascular and
ventilatory
changes during laparoscopic cholecystectomy under general anesthesia in 11 healthy patients. During operation, intraabdominal pressure was maintained automatically at 14mmHg by a CO2 insufflator and controlled ventilation setting was adjusted at
the
values of PaCO2 about 30mmHg before peritoneal insufflation, and this ventilatory setting was not changed throughout the operation. We measured peak inspiratory pressure (Ppi), mean arterial pressure (MAP), pulse rate (PR), arterial blood gas and
end
tidal carbon dioxide (PetCO2) before and during peritoneal insufflation, and after peritoneal exsufflation.
Peritoneal insufflation of CO2 resulted in a significant increase of Ppi, MAP, PaCO2 and PetCO2, a significant decrease of pH. And PaCO2 and pH were not restored until 15 minutes after CO2 exsufflation. PR and PaO2 were not changed significantly
throughout the operation.
Conclusively, during general anesthesia for laparoscopic cholecystectomy, hyperventilation was needed under the monitoring of PetCO2 or PetCO2 and special care and monitoring was mendatory for the patients with impaired cardiopulmonary function
and
increased intracranial pressure.
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