Variance of cardiorespiratory parameters during gynaecological surgery with CO2-pneumoperitoneum

• Published in: Endoscopic surgery and allied technologies Vol. 3; no. 4; p. 167
• Main Authors: Schleifer, W, Bissinger, U, Guggenberger, H, Heuser, D
• Format: Journal Article
• Language: English
• Published: Germany 01-08-1995
• Subjects: Abdomen; Adult; Anesthesia, General; Blood Pressure; Carbon Dioxide - administration & dosage; Carbon Dioxide - blood; Carbon Dioxide - metabolism; Central Venous Pressure; Female; Genitalia, Female - surgery; Head-Down Tilt; Heart - physiology; Heart Rate; Humans; Hydrogen-Ion Concentration; Inhalation; Insufflation - methods; Laparoscopy; Lung - physiology; Oxygen - blood; Pneumoperitoneum, Artificial; Pressure; Prospective Studies; Tidal Volume
• ISSN: 0942-6027

Laparoscopic procedures with CO2-pneumoperitoneum are used widely in gynaecology and surgery. The effects of a 15 degrees head-down position, different intra-abdominal pressures (IAP) and CO2-insufflation flows on cardiorespiratory parameters were studied prospectively in 18 gyneacologic patients under general anaesthesia. The 15 degrees head-down position led to significant changes in heart rate (-6%) and in central venous pressure (+53%). Furthermore, significant changes under commonly used conditions for gynaecological laparoscopy (IAP 9mmHg, CO2-insufflation flow 2.41/ min., 15 degrees head-down position) were found in heart rate (+16%), systolic blood pressure (+21%), diastolic blood pressure (+26%), central venous pressure (+57%), peak inspiratory pressure (+26%), end-tidal CO2-concentration (+19%), central venous pCO2 (+21%), and central venous pH (-7%). On examination of variable pressure and insufflation flows (IAP 3, 9, and 15mmHg; CO2-insufflation flows 1.2, 2.4, and 6.0 1/min.), increasing changes in heart rate (7% - 24%), diastolic blood pressure (22% - 33%), central venous pressure (30% - 59%) and peak inspiratory pressure (10% - 43%) correlated with increasing IAP. However, they were independent of CO2-insufflation flows. The results demonstrate that CO2-pneumoperitoneum causes marked changes in cardiorespiratory parameters, but these do not exceed levels commonly regarded as safe in ASA class I and II patients.