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Effect of prolonged inspiratory time on gas exchange during robot-assisted laparoscopic urologic surgery

Der Einfluss der verlängerten Einatmungszeit auf den Gasaustausch bei der robotergestützten laparoskopischen urologischen Chirurgie

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Abstract

Background

Gas exchange disturbance may develop during urologic robotic laparoscopic surgery with the patient in a steep Trendelenburg position. This study investigated whether prolonged inspiratory time could mitigate gas exchange disturbances including hypercapnia.

Methods

In this randomized cross-over trial, 32 patients scheduled for robot-assisted urologic surgery were randomized to receive an inspiratory to expiratory time ratio (I:E) of 1:1 for the first hour of pneumoperitoneum followed by 1:2 for last period of surgery (group A, n = 17) or I:E of 1:2 followed by 1:1 (group B, n = 15). Arterial blood gas analysis, airway pressure and hemodynamic variables were assessed at four time points (T1: 10 min after induction of general anesthesia, T2: 1 h after the initiation of pneumoperitoneum, T3: 1 h after T2 and T4: at skin closure). The carry over effect of initial I:E was also evaluated over the next hour through arterial blood gas analysis.

Results

There was a significant decrease in partial pressure of oxygen in arterial blood (PaO2) for both groups at T2 and T3 compared to T1 but in group B the PaO2 at T4 was not decreased from the baseline. Partial pressure of carbon dioxide in arterial blood (PaCO2) increased with I:E of 1:2 but did not significantly increase with I:E of 1:1; however, there were no differences in PaO2 and PaCO2 between the groups.

Conclusion

Decreased oxygenation by pneumoperitoneum was improved and PaCO2 did not increase after 1 h of I:E of 1:1; however, the effect of equal ratio ventilation longer than 1 h remains to be determined. There was no carryover effect of the two different I:E ratios.

Zusammenfassung

Hintergrund

Gasaustauschstörungen können bei der urologischen robotergestützten Laparoskopie unter steiler Trendelenburg-Position auftreten. Wir untersuchten, ob eine verlängerte Einatmungszeit Gasaustauschstörungen einschließlich Hyperkapnie mildern könnte.

Methoden

In dieser randomisierten „Cross-over“-Studie wurden 32 Patienten, die für die robotergestützte urologische Chirurgie vorgesehen waren, randomisiert, um ein inspiratorisches zu exspiratorisches Zeitverhältnis (I:E) von 1:1 für die erste Stunde Pneumoperitoneum gefolgt von 1:2 für das letzte Mal der Operation (Gruppe A, n = 17) oder I:E von 1:2, gefolgt von 1:1 (Gruppe B, n = 15), zu erhalten. Arterielle Blutgasanalyse, Atemwegsdruck und hämodynamische Variablen wurden zu 4 Zeitpunkten beurteilt (T1: 10 min nach Induktion der Vollnarkose; T2: 1 h nach Einleitung des Pneumoperitoneums; T3: 1 h nach T2; T4: bei Hautverschluss). Wir evaluierten auch den Verschleppungseffekt des initialen I:E über die nächste Stunde durch arterielle Blutgasanalyse.

Ergebnisse

Es gab eine signifikante Abnahme des Sauerstoffpartialdrucks im arteriellen Blut (paO2) für beide Gruppen bei T2 und T3 im Vergleich zu T1, aber in Gruppe B war der paO2 bei T4 nicht geringer als die Basislinie. Der Kohlendioxidpartialdruck im arteriellen Blut (paCO2) stieg mit I:E von 1:2, aber nicht signifikant mit I:E von 1:1. Allerdings gab es keinen Unterschied in paO2 und PaCO2 zwischen den Gruppen.

Schlussfolgerungen

Die verminderte Sauerstoffversorgung durch das Pneumoperitoneum wurde verbessert, und der paCO2-Wert stieg nach 1h I:E von 1:1 nicht an. Der Effekt einer gleichmäßigen Beatmung, die länger als 1h dauert, muss jedoch noch bestimmt werden. Es gab keinen Übertragungseffekt von 2 verschiedenen I:E-Verhältnissen.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Korea (Republic of)

    M. Hur, S.-K. Park, D. E. Jung, S. Yoo, J.-Y. Choi, W. H. Kim M.D.,Ph.D., J. T. Kim & J.-H. Bahk

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  1. M. Hur
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  2. S.-K. Park
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  3. D. E. Jung
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  6. W. H. Kim M.D.,Ph.D.
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Correspondence to W. H. Kim M.D.,Ph.D..

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Conflict of interest

M. Hur, S.-K. Park, D. E. Jung, S. Yoo, J.-Y. Choi, W. H. Kim, J.T. Kim and J.-H. Bahk declare that they have no competing interests.

This study was approved by the Institutional Review Board of Seoul National University Hospital (register number 1609-102-793). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants in the study.

Caption Electronic Supplementary Material

ESM1_Text 1: Grizzle’s two-stage model testing the presence of carryover effect

101_2018_486_MOESM2_ESM.docx

ESM2_Table 1. Combined results of arterial blood gas analysis, respiratory mechanics and hemodynamic parameters according to the I:E of 1:1 or 1:2 regardless of the study group

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Hur, M., Park, SK., Jung, D.E. et al. Effect of prolonged inspiratory time on gas exchange during robot-assisted laparoscopic urologic surgery. Anaesthesist 67, 859–867 (2018). https://doi.org/10.1007/s00101-018-0486-6

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