html5-img
1 / 9

Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum

Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum. Acta anaesthesiol Scand 2005;49:778-783 R2 김용일. Background. Pneumoperitoneum of laparoscopic surgery By insufflating gas – m/c carbon dioxide Highly soluble, non-combustible

aric
Télécharger la présentation

Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum Acta anaesthesiol Scand 2005;49:778-783 R2 김용일

  2. Background • Pneumoperitoneum of laparoscopic surgery • By insufflating gas – m/c carbon dioxide • Highly soluble, non-combustible  increases intra-abadominal pressure • Cephalad displacement of diaphragm • Decreased lung volumes (including FRC) • Decreased compliance • Increased resistance & ventilation-perfusion mismatch  leads to formation of atelectasis • More exacerbated in head-down position • Reduce FRC below closing volume • Predisposes to airway closure and atelectasis

  3. During short laparoscopic procedures • Seldom have clinically significant adverse effects • Expansion of laparoscopic techniques • Became longer and applied to broader patient population • Experience with long-term pneumoperitoneum is still limited • The aim of this study • Investigate the repiratory and hemodynamic effects of mechanical ventilation • With & without PEEP during prolonged pneumoperitoneum

  4. Methods

  5. Totally endoscopic robot-assited radical prostatectomy – 20 patients • PEEP group (n=10) • Constant PEEP of 5 cmH2O • ZPEEP group (n=10) • No PEEP • Intraabdominal CO2-insufflation pressure •  12mmHg in both groups • Patients with pulmonary disease were excluded

  6. Anesthesia • Induction & maintenance by IV anesthesia • Remifentanil, propofol, mivacurium • Controlled ventilation with oxygen 50% in air • In group PEEP : constant PEEP of 5 cmH2O • Maintain physiologic pH, BE, HCO3-, PaCO2 • Neuromuscular monitoring, intraop ECG, pulse oximetry & arterial BP monitoring • Heating blanket • Postop anagesia • Piritramide 7.5mg, metamizol 1g

  7. Assessment of outcome variables • Arterial blood gas analyses • pH, base excess (BE), HCO3-, PaCO2, PaCO2 • Heart rate, mean arterial blood pressure, contral venous pressure, minute ventilation • Baseline values • In Trendelenburg position prior to CO2 insufflation • Further data collection • In 10 & 30 min, 1, 2, 3 & 4 h after pneumoperitoneum creation • Final assessment • Immediately after surgery, still in Terendelenburg position • AaDo2 = [BP – 47] X FiO2 – PaCO2 – PaO2 • Alveolar-arterial difference in oxygen tension • BP : barometric pressure (=760mmHg)

  8. Results

  9. Demographics • No case of complications & conversion to open technique • Overall pneumoperitoneum duration • 474 min in PEEP group • 577 min in ZPEEP group

More Related