Sixteen women were studied during elective diagnostic laparoscopy with CO2-insufflation to an intraabdominal pressure (IAP) of 2 kPa and Trendelenburg tilt to 30 degrees. They were allocated to either a halothane (Group I) or a balanced (Group II) anaesthesia with relaxation and controlled ventilation. Heart rate (HR), arterial pressure, stroke volume, CO2-elimination, end-tidal CO2 vol.% and total respiratory compliance (TRC) were the parameters measured, and mean arterial pressure (MAP), total peripheral resistance (TPR), stroke index (SI) and cardiac index (CI) were calculated. At maximum haemodynamic strain, SI and CI were on average reduced by 42% in both groups, without significant changes in HR and MAP. TPR increased by 50% in Group I and 100% in Group II. The reduction in SI was related to the changes in TRC. A small increment in CO2-elimination after CO2-insufflation was most pronounced in Group II. SI and CI did not reach the pre-insufflation values after return to the horizontal position and CO2-exsufflation. The haemodynamic differences between the two groups were small compared to the effects of the laparoscopy procedures.

The effect of three postoperative regimens of respiratory therapy on pulmonary complications and lung function was compared in high-risk patients. Fifty-one patients were randomized to: 1) conventional chest physiotherapy alone (PHYS), 2) chest physiotherapy and positive expiratory pressure (PEP), or 3) chest physiotherapy with both positive expiratory pressure and inspiratory resistance (RMT). Treatments were given twice daily by a physiotherapist and self-administered. The incidence of postoperative pulmonary complications (PPC) was respectively, 71%, 76% and 65% in the PHYS-, PEP- and RMT-groups. The incidence of PPC requiring treatment with antibiotic, bronchodilator or supplementary oxygen according to the existing clinical practice was 47%, 47% and 29%. The incidence of atelectasis was 65%, 64% and 60% and of pneumonia 29%, 35% and 6%. There was no difference between the groups, except for a tendency to a lower frequency of pneumonia in the RMT-group. Postoperatively forced vital capacity (FVC) decreased to mean 54%, forced expired volume in 1 s to 48% and functional residual capacity to 76% of preoperative values. Arterial oxygen tension (PaO2) declined to mean 8.1 kPa and arterial saturation (SaO2) to 89%. There was no difference between the groups except for FVC, PaO2 and SaO2 (P = 0.008, P = 0.008 and P = 0.002), which showed the least decrease in the RMT-group. None of the regimens could be considered as satisfactory concerning the prevention of PPC, but RMT seemed to be the most efficient. Insufficient self-administration of treatment was probably one of the causes of the overall high incidence of PPC in this study.

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Antroduodenal motility, pH and gastric emptying rate were measured in 11 patients undergoing orthopaedic or plastic surgery with general anaesthesia. Motility was measured by manometry and gastric emptying rate by the rate of paracetamol absorption. During anaesthesia, gastric emptying was delayed in eight patients. General anaesthesia with halothane reduced the duration of the interdigestive motility complex (P less than 0.01), mainly by a shortening of phase II (P less than 0.01) which correlated with the inhaled concentrations of halothane (P less than 0.01). Anaesthesia impeded the occurrence of antral contractions during phase II (P less than 0.01); the frequency of contractions was unchanged during anaesthesia, but decreased during the recovery period (P less than 0.01). The amplitudes of antral contractions diminished with anaesthesia (P less than 0.01), but increased after operation. The frequency of contractions in the duodenum was unchanged during phase II and reduced during phase III (P less than 0.01). Gastric pH increased during and after operation (P less than 0.01). General anaesthesia with halothane affects gastroduodenal motility especially during phase II, increases gastric pH and delays gastric emptying rate.