Physiologic effects of pneumoperitoneum in adults with sickle cell disease undergoing laparoscopic cholecystectomy (A case control study)
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- Youssef, M.A.M. & Mulhim, A.A. Surg Endosc (2008) 22: 1513. doi:10.1007/s00464-007-9624-y
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Many studies have demonstrated the adverse consequences of pneumoperitoneum. However, few studies have examined the physiologic effects of pneumoperitoneum in adults with sickle cell disease (SCD) during laparoscopic cholecystectomy (LC).
60 ASA 1-П П patients, with cholelithiasis, scheduled for elective LC were allocated into two equal groups: group 1, normal patients without SCD (control group), and group 2, patients with SCD. The perioperative parameters of 30 SCD patients matched by age and sex to the 30 members of the non-sickler control group who underwent cholecystectomy were assessed. Study parameters (in the two groups) included heart rate (HR) per minute, mean blood pressure (MAP, mmHg), PETCO2, and O2 saturation (SpO2) at the following intervals: before induction of anesthesia in the supine position (all except PETCO2), after anesthesia and before CO2 insufflations in the supine position, 15, 30, 45, 60 min after CO2 insufflations in the anti-Trendelenburg position, at the end of CO2 exsufflation in the supine position and 5 min after the end of CO2 exsufflation in the supine position. Arterial blood gases, to measure pH, PaCO2, and PaO2, were determined after induction of anesthesia and before CO2 insufflation in the supine position, then 30 min after CO2 insufflations in the anti-Trendelenburg position, and 5 min after the end of CO2 exsufflation in the supine position. Statistical significance was established at the p < 0.05 level.
Induction of anesthesia produced a significant increase in HR in both groups. CO2 insufflations led to an additional increase in HR and persisted till abdominal deflation. After CO2 insufflations, MAP significantly increased from the baseline at 15, 30, 45, and 60 min, and just before deflation in the anti-Trendelenburg position. CO2 insufflations led to a significant increase in end-tidal CO2 (ETCO2) in the study groups, reaching a maximum level just before abdominal deflation in the anti-Trendelenburg position. Regarding SpO2 and PaO2, there were insignificant changes in the two study groups throughout the procedure. In group 2, none of the patients experienced vaso-occlusive crises or other SCD- related complications.
This study proved the safety of LC in patients with SCD and cholelithiasis, and that they can tolerate the physiological effects of pneumoperitoneum as non-SCD adults.