RESPIRATORY COMPLIANCE DURING LAPAROSCOPIC HIATAL AND INGUINAL-HERNIAREPAIR

Citation
Mt. Makinen et A. Ylihankala, RESPIRATORY COMPLIANCE DURING LAPAROSCOPIC HIATAL AND INGUINAL-HERNIAREPAIR, Canadian journal of anaesthesia, 45(9), 1998, pp. 865-870
Citations number
18
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0832-610X
Volume
45
Issue
9
Year of publication
1998
Pages
865 - 870
Database
ISI
SICI code
0832-610X(1998)45:9<865:RCDLHA>2.0.ZU;2-9
Abstract
Purpose: Side stream spirometry with dynamic compliance displayed as p ressure-volume loops, has enabled early detection of CO2 pneumothorax during pneumoperitoneum. We compared dynamic compliance profiles of tw o laparoscopic procedures with different patient positions. Methods: I n 26 patients, scheduled either for laparoscopic fundoplication in ahe ad-up tilt or inguinal herniorrhaphy in a head-down tilt, dynamic comp liance was measured with continuous spirometry from anaesthesia induct ion until skin closure. Control pressure-volume loops were saved in th e horizontal position before surgery and compared with succeeding loop s in the head-up / head-down tilt before pneumoperitoneum, during pneu moperitoneum in the horizontal and the tilt position, after evacuation of pneumoperitoneum in the tilt and finally in the horizontal positio n. Results: Pneumoperitoneum reduced compliance in both groups by 35% (P < 0.01). Head-down tilt decreased compliance by 12% before and duri ng pneumoperitoneum (P < 0.01). Head-up tilt increased compliance by 4 % before pneumoperitoneum (P < 0.05), but during pneumoperitoneum it h ad no effect, After evacuation of pneumoperitoneum compliance returned immediately to control in head-up tilt, but remained reduced in head- down tilt and was not at control after adopting horizontal position (P < 0.05). Difference between the groups was significant (P < 0.01) in the head-up / head-down tilt before, during and immediately after pneu moperitoneum. Conclusion: Both pneumoperitoneum and head-up and head-d own positions had characteristic effects on dynamic compliance, Simult aneous display of sequential pressure-volume loops enabled immediate d etection of changes in respiratory mechanics.