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Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum

Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum. Acta anaesthesiol Scand 2005;49:778-783 R2 김용일. Background. Pneumoperitoneum of laparoscopic surgery By insufflating gas – m/c carbon dioxide Highly soluble, non-combustible

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Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum

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  1. Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum Acta anaesthesiol Scand 2005;49:778-783 R2 김용일

  2. Background • Pneumoperitoneum of laparoscopic surgery • By insufflating gas – m/c carbon dioxide • Highly soluble, non-combustible  increases intra-abadominal pressure • Cephalad displacement of diaphragm • Decreased lung volumes (including FRC) • Decreased compliance • Increased resistance & ventilation-perfusion mismatch  leads to formation of atelectasis • More exacerbated in head-down position • Reduce FRC below closing volume • Predisposes to airway closure and atelectasis

  3. During short laparoscopic procedures • Seldom have clinically significant adverse effects • Expansion of laparoscopic techniques • Became longer and applied to broader patient population • Experience with long-term pneumoperitoneum is still limited • The aim of this study • Investigate the repiratory and hemodynamic effects of mechanical ventilation • With & without PEEP during prolonged pneumoperitoneum

  4. Methods

  5. Totally endoscopic robot-assited radical prostatectomy – 20 patients • PEEP group (n=10) • Constant PEEP of 5 cmH2O • ZPEEP group (n=10) • No PEEP • Intraabdominal CO2-insufflation pressure •  12mmHg in both groups • Patients with pulmonary disease were excluded

  6. Anesthesia • Induction & maintenance by IV anesthesia • Remifentanil, propofol, mivacurium • Controlled ventilation with oxygen 50% in air • In group PEEP : constant PEEP of 5 cmH2O • Maintain physiologic pH, BE, HCO3-, PaCO2 • Neuromuscular monitoring, intraop ECG, pulse oximetry & arterial BP monitoring • Heating blanket • Postop anagesia • Piritramide 7.5mg, metamizol 1g

  7. Assessment of outcome variables • Arterial blood gas analyses • pH, base excess (BE), HCO3-, PaCO2, PaCO2 • Heart rate, mean arterial blood pressure, contral venous pressure, minute ventilation • Baseline values • In Trendelenburg position prior to CO2 insufflation • Further data collection • In 10 & 30 min, 1, 2, 3 & 4 h after pneumoperitoneum creation • Final assessment • Immediately after surgery, still in Terendelenburg position • AaDo2 = [BP – 47] X FiO2 – PaCO2 – PaO2 • Alveolar-arterial difference in oxygen tension • BP : barometric pressure (=760mmHg)

  8. Results

  9. Demographics • No case of complications & conversion to open technique • Overall pneumoperitoneum duration • 474 min in PEEP group • 577 min in ZPEEP group

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