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Laparoscopic cholecystectomy is an exciting development in the surgical management of cholelithiasis, as it avoids the traditional large upper abdominal incision with associated postoperative pain, disability, and slow return to normal work. Air, nitrous oxide, an pure oxygen have each been evaluated as agents for insufflation in gynecologic laparoscopic procedures. Complication attibuted to gas insufflation include fatal embolism, passive absorption and intraabdominal explosions resulting from electrocautry with inflammable gases. Laparoscopic cholecystectomy uses carbon dioxide, a highly diffusable gas, for insufflation of peritoneal cavity. The most common complications is the increasedx postoperative shoulder pain when CO2 was used. With extended periods of insufflation, patient's arterial carbon dioxide levels may be adversely affected. We studied the effects of laparoscopic cholecystectomy on respiratory and hemodynamic function in fifty patients, and compared the results with those from conventional open cholecystectomy. Hemodynamic and ventilatory variables were measured before peritoneal insufflation, at interval during surgery and postoperative recovery room. Measurements of PaCO2, PaO2, O2 saturation, pH, mean arterial pressure and heart rate were undertaken in each fifty patients undergoing laparoscopy and laparotomy. Carbon dioxide pneumoperitoneum was maintained at a constant pressure of 15 mmHg during cholecystectomy. After 30 minutes of operation, the PACO2 increased from 36.8±2.58 mmHg to 40.3±3.51 mmHg and arterial pH fell from 7.40±0.03 to 7.37±0.06. CO2 pneumoperitoneum resulted in significant transperitoneal CO2 absorption, with secondary hypercapnia and acidemia. Heart rate increased to compensate the decreased stroke volume to maintain cardiac output. Hemodynamic changes during laparoscopic procedure were not quite different from the data of conventional cholecystectomy. In conclusion, CO2 insufflation did not alter the hemodynamic and ventilatory functions of the patient.
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