Changes in Lung and Chest Wall Properties with Abdominal Insufflation of Carbon Dioxide Are Immediately Reversible

Abstract

Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.

Laparoscopic Cholecystectomy for Patients with Chronic Obstructive Pulmonary Disease

“…This, however, was not associated with a greater likelihood of postoperative pulmonary complications or a prolonged postoperative hospital stay in comparison with non-COPD patients. This observation may be partially explained by the work of Fahy et al 13 They found that large increases in lung resistance and lung and chest wall stretch, which occur during abdominal CO 2 insufflation before laparoscopic surgery, are largely reversible on abdominal deflation. In addition, Galizia et al 14 compared hemodynamic and pulmonary changes during open CO 2 pneumoperitoneum with those during abdominal walllifting cholecystectomy.…”

Pulmonary function after laparoscopic and open cholecystectomy

“…The difference in respiratory function after laparoscopic and open cholecystectomy cannot be explained by differences in anesthesia, duration of operation, or postoperative care in patients. Several other mechanisms may be responsible for the marked depression of pulmonary function after upper abdominal surgery, including surgical incision, local abdominal pain, and dia- phragm dysfunction [6,7,11,15]. After upper abdominal surgery, diaphragmatic excursion is decreased, and paradoxical motion of the diaphragm may occur, which leads to increased demand on intercostal muscle contribution to respiration [7].…”

Evaluation of arterial to end-tidal carbon dioxide pressure differences during laparoscopic renal surgery in the lateral decubitus position

“…Laparoscopic procedures performed with CO 2 pneumoperitoneum increase CO 2 load by absorption of CO 2 via peritoneal surface. There may also be a decrease in both thoracic compliance[34] and FRC. [1516] In majority of the studies, PaCO 2 , PEtCO 2 , and P (a-Et) CO 2 have been found to increase and affected by duration of pneumoperitoneum and body position.…”

“…[2] Further, creation of pneumoperitoneum during laparoscopy decreases functional residual capacity (FRC) and thoracic compliance and increases CO 2 load in the body. [34] Therefore, we hypothesized that patients undergoing laparoscopic renal surgeries in LDP may show significant variations inP (a-Et) CO 2 in comparison to the LDP alone. However, no study has been carried out to determine these changes in the past.…”