Comparative Study of Ventilation with and Without Positive End Expiratory Pressure during Anesthesia for Laparoscopic Surgeries
- 1. Assistant Professor, Department of Anaesthesia, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar
- 2. Associate Professor and Head of Department, Department of Anaesthesia, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar
Description
Background: Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. Methods: 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparoscopic cholecystectomy were enrolled. They were randomized into two groups of 30 each. Group P received PEEP of 10 cm during laparoscopy and group C did not receive any PEEP. The vital parameters, arterial blood gases, and airway pressures were compared in both groups. Results: The oxygenation, (PaO2/FiO2 ratio) was significantly higher in PEEP group (446. 4±113.32 mm of Hg) as compared to the control group (404 ± 51.4 mm of Hg) after one hour of laparoscopy (P= 0.0037). The control group had higher arterial carbon dioxide tension (42.84 ± 2.38 mm of Hg) as compared to PEEP group (41.86 ± 2.33 mm of Hg), (P < 0.001). Both the findings suggest better ventilation perfusion matching in PEEP group. There was a no significant variation in mean arterial pressure and heart rate due to PEEP in our patient population. However the peak airway pressures were significantly higher in PEEP group. Conclusion: 10 cm of PEEP helped in better oxygenation with no significant hemodynamic alterations, in otherwise healthy patients undergoing laparoscopic cholecystectomy.
Abstract (English)
Background: Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. Methods: 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparoscopic cholecystectomy were enrolled. They were randomized into two groups of 30 each. Group P received PEEP of 10 cm during laparoscopy and group C did not receive any PEEP. The vital parameters, arterial blood gases, and airway pressures were compared in both groups. Results: The oxygenation, (PaO2/FiO2 ratio) was significantly higher in PEEP group (446. 4±113.32 mm of Hg) as compared to the control group (404 ± 51.4 mm of Hg) after one hour of laparoscopy (P= 0.0037). The control group had higher arterial carbon dioxide tension (42.84 ± 2.38 mm of Hg) as compared to PEEP group (41.86 ± 2.33 mm of Hg), (P < 0.001). Both the findings suggest better ventilation perfusion matching in PEEP group. There was a no significant variation in mean arterial pressure and heart rate due to PEEP in our patient population. However the peak airway pressures were significantly higher in PEEP group. Conclusion: 10 cm of PEEP helped in better oxygenation with no significant hemodynamic alterations, in otherwise healthy patients undergoing laparoscopic cholecystectomy.
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IJPCR,Vol16,Issue6,Article289.pdf
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Additional details
Dates
- Accepted
-
2024-05-26
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue6,Article289.pdf
- Development Status
- Active
References
- 1. Meininger D, Byhahn C, Mierdl S, Westphal K, Zwissler B. Positive end expiratory pressure improves arterial oxygenation during pneumoperitoneum. Acta Anaesthesiol Scand. 2005; 49:778–83. 2. Kim JY, Kim HS, Jung WS, Kwak HJ. Positive end expiratory pressure in pressure controlled ventilation improves ventilator oxygenation parameters during laparoscopic cholecystectomy. Surg Endosc. 2010; 24:1099–103. 3. Talab HF, Zabani IA, Abdelrahman HS, Bukhari WL, Mamoun I, Ashour MA, et al. Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Laparoscopic Bariatric Surgery. Anesth Analg. 2009; 109(5):1511–6. 4. Güldner A, Kiss T, Neto AS, Hemmes SNT, Canet J, Spieth PM, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiol. 2015; 123:692–713. 5. Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics. L Pulmonary densities during anesthesia with muscular relaxation: A proposal of atelectasis. Anesthesiology. 1985; 62:422–430. 6. Levin MA, Mccormick, Pj, Lin, Hm, Hosseinian L, et al. GW Low intraoperative tidal volume ventilation with minimal PEEP is associated with increased mortality. Br J Anaesth. 2014; 113:97–108. 7. Sen O, Doventas YE. Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy. Braz J Anesthesiol. 2017; 67(1):28–34. 8. Hemmes SN, Abreu GD, Pelosi M, Schultz P, Prove MJ. Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology: High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): A multicentre randomised controlled trial. Lancet. 2014; 384:495–503. 9. Maisch S, Reissmann H, Fuellekrug B, Weismann D, Rutkowski T, Tusman G, et al. Compliance and dead space fraction indicate an optimal level of positive end-expiratory pressure after recruitment in anesthetized patients. Anesth Analg. 2008; 106:175–81. 10. Pereira SM, Tucci MR, Morais CCA, Simões CM, Tonelotto BFF, Pompeo MS, et al. Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis.Anesthesiol. 2018; 129(6):1070–81.11. Nakamura MAM, Hajjar LA, Galas FR, Ortiz TA, Amato MBP. Positive end expiratory pressure titration at bedside using electrical impedance tomography. Intensive Care Med Exp. 2016; 4:126–7. 12. Nestler C, Simon P, Petroff D, Hammermüller S, Kamrath D, Wolf S, et al. H Individualized positive end-expiratory pressure in obese patients during general anaesthesia: A randomized controlled clinical trial using electrical impedance tomography. Br J Anaesth. 2017; 119:1194–205. 13. Örnek D, Çiçek F, Ün C, Kılcı O, Gamlı M, Türkaslan D. The effects of 10 cmH 2 O positive end-expiratory pressure on arterial oxygenation, respiratory mechanics and hemodynamic parameters in laparoscopic cholecystectomy operations. J Clin Exp Investig. 2014; 5(3):397–402. 14. Kundra P, Subramani Y, Ravishankar M, Sistla SC, Nagappa M, Sivashanmugam T. Cardiorespiratory Effects of Balancing PEEP With Intra-abdominal Pressures During Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutaneous Tech. 2014; 24(3):232–9.