Advertisement

Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass

  • N. T. NguyenEmail author
  • J. T. Anderson
  • M. Budd
  • N. W. Fleming
  • H. S. Ho
  • J. Jahr
  • C. M. Stevens
  • B. M. Wolfe
Original article

Abstract

Background: Hypercarbia and elevated intraabdominal pressure resulting from carbon dioxide (CO2) pneumoperitoneum can adversely affect respiratory mechanics. This study examined the changes in mechanical ventilation, CO2 homeostasis, and pulmonary gas exchange in morbidly obese patients undergoing a laparoscopic or open gastric bypass (GBP) procedure. Methods: In this study, 58 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly allocated to laparoscopic (n = 31) or open (n = 27) GBP. Minute ventilation was adjusted to maintain a low normal arterial partial pressure of CO2 (PaCO2), low normal end-tidal partial pressure of CO2 (ETCO2), and low airway pressure. Respiratory compliance, ETCO2, peak inspiratory pressure (PIP), total exhaled CO2 per minute (VCO2), and pulse oximetry (SO2) were measured at 30-min intervals. The acid–base balance was determined by arterial blood gas analysis at 1-h intervals. The pulmonary gas exchange was evaluated by calculation of the alveolar dead space–to–tidal volume ratio (VDalv/VT) and alveolar–arterial oxygen gradient (PAO2–PaO2). Results: The two groups were similar in age, gender, and BMI. As compared with open GBP, laparoscopic GBP resulted in higher ETCO2, PIP, and VCO2, and a lower respiratory compliance. Arterial blood gas analysis demonstrated higher PaCO2 and lower pH during laparoscopic GBP than during open GBP (p < 0.05). The VDalv/VT ratio and PAO2–PaO2 gradient did not change significantly during laparoscopic GBP. Intraoperative oxygen desaturation (SO2 < 90%) did not develop in any of the patients in either group. Conclusions: Laparoscopic GBP alters intraoperative pulmonary mechanics and acid–base balance but does not significantly affect pulmonary oxygen exchange. Changes in pulmonary mechanics are well tolerated in morbidly obese patients when proper ventilator adjustments are maintained.

Keywords

Morbid obesity Laparoscopy Gastric bypass Respiratory mechanics 

References

  1. 1.
    Arnold, JH, Thompson, JE, Arnold, LW 1996Single-breath CO2 analysis: description and validation of a method.Crit Care Med2496102PubMedGoogle Scholar
  2. 2.
    Damia, G, Mascheroni, D, Croci, M, Tarenzi, L 1988Perioperative changes in functional residual capacity in morbidly obese patients.Br J Anaesth60574578PubMedGoogle Scholar
  3. 3.
    Dumont, L, Mattys, M, Mardirosoff , C,  et al. 1997Changes in pulmonary mechanics during laparoscopic gastroplasty in the morbidly obese patient.Acta Scand Anesth4148413Google Scholar
  4. 4.
    Fujise, K, Shingu, K, Matsumoto, S 1998The effects of lateral position on cardiopulmonary function during laparoscopic urological surgery.Anesth Analg87925930Google Scholar
  5. 5.
    Hardman, JG, Aitkenhead, AR 1999Estimation of alveolar dead space fraction using arterial and end-tidal CO2: a factor analysis using a physiological simulation.Anaesth Intensive Care27452458PubMedGoogle Scholar
  6. 6.
    Hedenstierna, G, Santesson, J 1976Breathing mechanics, dead space, and gas exchanges in the extremely obese, breathing spontaneously and during anesthesia with intermittent positive pressure ventilation.Acta Anaesthesiol Scand20248254PubMedGoogle Scholar
  7. 7.
    Galizia, G, Prizio, G, Lieto, E 2001Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum, and abdominal wall-lifting cholecystectomy.Surg Endosc15477483CrossRefPubMedGoogle Scholar
  8. 8.
    Higa, KD, Boone, KB, Ho, T 2000Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned?Obes Surg10509513CrossRefPubMedGoogle Scholar
  9. 9.
    Leighton, T, Pianim, N, Liu, S-Y 1992Effectors of hypercarbia during experimental pneumoperitoneum.Am Surg58717721PubMedGoogle Scholar
  10. 10.
    Lindgren, L, Koivusalo, AM, Kellokumpu, I 1995Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy.Br J Anaesth75567752PubMedGoogle Scholar
  11. 11.
    Mullett, CE, Viale, JP, Sagnard, PE,  et al. 1993Pulmonary CO2 elimination during surgical procedures using intra- or extraperitoneal CO2 insufflation.Anesth Analg76622626Google Scholar
  12. 12.
    Nguyen, NT, Goldman, C, Rosenquist, CJ,  et al. 2001Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.Ann Surg234279291CrossRefPubMedGoogle Scholar
  13. 13.
    Nguyen, NT, Ho, HS, Palmer, LS, Wolfe, BM 2000A comparison study of laparoscopic versus open gastric bypass for morbid obesity.J Am Coll Surg191149155CrossRefPubMedGoogle Scholar
  14. 14.
    Nguyen, NT, Lee, SL, Goldman, C 2001Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial.J Am Coll Surg192469476CrossRefPubMedGoogle Scholar
  15. 15.
    Puri, GD, Singh, H 1992Ventilatory effects of laparoscopy under general anesthesia.Br J Anaesth68211213PubMedGoogle Scholar
  16. 16.
    Ray, CS, Sue, DY, Bray, G 1983Effects of obesity on respiratory function.Am Rev Resp Dis128501508PubMedGoogle Scholar
  17. 17.
    Schauer, PR, Ikramuddin, S, Gourash, W 2000Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.Ann Surg232515529CrossRefPubMedGoogle Scholar
  18. 18.
    Sharma, KC, Brandstetter, RD, Brensilver, JM, Jung, LD 1996Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery.Chest110810815PubMedGoogle Scholar
  19. 19.
    Tan, PL, Lee, TL, Tweed, WA 1992Carbon dioxide absorption and gas exchange during pelvic laparoscopy.Can J Anaesth39677681PubMedGoogle Scholar
  20. 20.
    Wahba, RW, Beique, F, Kleiman, SJ 1995Cardiopulmonary function and laparoscopic cholecystectomy.Can J Anesth425163Google Scholar
  21. 21.
    Wittgrove, AC, Clark, GW 2000Laparoscopic gastric bypass, Roux-en-Y 500 patients: technique and results, with 3–60-month follow-up.Obes Surg10233239PubMedGoogle Scholar
  22. 22.
    Girardis, M, Broi, UD, Antonutto, G, Pasetto, A 1996The effect of laparoscopic cholecystectomy on cardiovascular function and pulmonary gas exchange.Anesth Analg83134140Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • N. T. Nguyen
    • 1
    Email author
  • J. T. Anderson
    • 2
  • M. Budd
    • 1
  • N. W. Fleming
    • 3
  • H. S. Ho
    • 2
  • J. Jahr
    • 3
  • C. M. Stevens
    • 1
  • B. M. Wolfe
    • 2
  1. 1.Department of SurgeryUniversity of California, Irvine Medical Center, 101 The City Drive, Building 55, Room 106, Orange, CA 92868USA
  2. 2.Department of SurgeryUniversity of California, Davis Medical Center, Sacramento, CA 95817USA
  3. 3.Department of AnesthesiologyUniversity of California, Davis Medical Center, Sacramento, CA 95817USA

Personalised recommendations