Surgical Endoscopy

, Volume 26, Issue 2, pp 391–397 | Cite as

Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?

  • Mohamed R. El-TahanEmail author
  • Noha D. Al Dossary
  • Hatem El Emam
  • Douaa G. Diab
  • Abdulhadi Al’Saflan
  • Haitham Zien
  • Mona Al Ahmadey
  • Afrah Deria



Hypocapnia before and during carbon dioxide (CO2) insufflation for laparoscopic cholecystectomy may reduce the adverse hemodynamic responses.


After ethical approval, 100 patients scheduled for laparoscopic cholecystectomy were ventilated using a tidal volume of 8 ml/kg, an inspiration:expiration ratio of 1:2.5, and a positive end-expiratory pressure (PEEP) of 5 cm H2O. At 15 min before CO2 insufflation, the patients were randomly allocated into two groups of 50 patients each. For the normocapnia group, the respiratory rate (RR) was adjusted to maintain arterial CO2 tension (PaCO2) at 35 to 45 mmHg. For the hypocapnia group, the RR was adjusted to maintain PaCO2 at 30 to 35 mmHg. Anesthesia was maintained with sevoflurane 2% to 2.5% in 40% air oxygen and rocuronium. Hemodynamic variables, PaCO2, end-tidal CO2 tension (EtCO2), arterial-to-end-tidal CO2 (Pa-ETCO2) gradient, and RR were recorded.


Compared with the control group, the use of hypocapnia before and during pneumoperitoneum was associated with significantly lower arterial blood pressures, lower PaCO2 and EtCO2 values, a higher Pa-ETCO2, a higher RR (p < 0.001), and less need for supplemental doses of fentanyl and labetalol.


The authors conclude that the use of hypocapnia before and during CO2 insufflation is effective in attenuating increases in blood pressure after CO2 pneumoperitoneum during anesthesia for laparoscopic cholecystectomy.


Anesthesia CO2 insufflation Hemodynamic Hypocapnia Laparoscopic cholecystectomy 



Mohamed R. El-Tahan, Noha D. Al Dossary, Hatem El Emam, Douaa G. Diab, Abdulhadi Al’Saflan, Haitham Zien, Mona Al Ahmadey, and Afrah Deria have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Mohamed R. El-Tahan
    • 1
    • 6
    Email author
  • Noha D. Al Dossary
    • 2
  • Hatem El Emam
    • 3
  • Douaa G. Diab
    • 4
  • Abdulhadi Al’Saflan
    • 3
  • Haitham Zien
    • 5
  • Mona Al Ahmadey
    • 4
  • Afrah Deria
    • 3
  1. 1.Department of Anaesthesia and Surgical ICUCollege of Medicine, University of DammamDammamSaudi Arabia
  2. 2.Department of AnaesthesiaKing Abdul Aziz Airbase HospitalDhahranSaudi Arabia
  3. 3.Department of Anaesthesia and Surgical ICUKing Fahd Hospital of the University of DammamDammamSaudi Arabia
  4. 4.Mansoura University HospitalsCollege of Medicine, Mansoura UniversityMansouraEgypt
  5. 5.Department of Cardiac AnaesthesiaPrince Sultan Cardiac CentreRiyadhSaudi Arabia
  6. 6.College of Medicine, Mansoura UniversityMansouraEgypt

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