Diaphragm Function and Pulmonary Complications After Laparoscopic Cholecystectomy

Sha, Muneyasu; Ohmura, Akito; Yamada, Michiyo

doi:10.1097/00000542-199109001-00255

Cited by 7 publications

(4 citation statements)

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“…Pneumoperitoneum reduces pulmonary volumes [1][2][3], and may affect respiratory mechanics [4,5], as observed previously. However, no data have previously been reported concerning respiratory system, lung, and chest wall viscous, elastic, and viscoelastic mechanical properties during pneumoperitoneum.…”

Section: Discussionsupporting

confidence: 71%

“…According to SHA et al [1], using chest radiographs, during pneumoperitoneum there is a marked cephalad shift of the inspiratory and the expiratory position of the diaphragm. FRC was also reduced.…”

Section: Circumferences CMmentioning

confidence: 99%

“…During laparoscopy, a pneumoperitoneum is generated, which may yield several respiratory changes, e.g. pulmonary atelectasis [1], decreased functional residual capacity (FRC) and vital capacity (VC) [1][2][3], reduced pulmonary compliance [4,5], and increased peak airway pressure [2,6]. Although these alterations are important, no comprehensive analysis of respiratory mechanics has previously been reported during pneumoperitoneum.…”

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confidence: 99%

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Respiratory mechanics and morphometric changes during pneumoperitoneum in normal rats

Moreira

Gobbi²,

Feijoo³

et al. 1997

Eur Respir J

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Pneumoperitoneum may give rise to several respiratory changes; nevertheless, no comprehensive analysis of respiratory mechanics has been performed under this condition.Respiratory mechanics and thoracoabdominal morphometry were evaluated in six sedated, anaesthetized, paralysed, and mechanically-ventilated rats before (control) and during pneumoperitoneum. After airway occlusion at end-inspiration, respiratory system, pulmonary, and chest wall resistive pressures (∆P1,rs, ∆P1,L and ∆P1,cw, respectively) and viscoelastic/inhomogeneous pressures (∆P2,rs, ∆P2,L and ∆P2,cw, respectively) were determined. Total pressure changes (∆Ptot) were calculated as the sum of ∆P1 and ∆P2, yielding the values of ∆Ptot,rs, ∆Ptot,L and ∆Ptot,cw, respectively. Respiratory system, lung, and chest wall static (Est,rs, Est,L and Est,cw, respectively), and dynamic elastances (Edyn,rs, Edyn,L and Edyn,cw, respectively), and the corresponding changes in elastance (∆E) (calculated as Edyn-Est) were also obtained. Chest wall configuration both at functional residual capacity (FRC) and end-inspiration (FRC + tidal volume (VT)) was also evaluated in another four rats.Pneumoperitoneum significantly increased ∆Ptot,rs, ∆Ptot,cw, ∆P2,rs, AP2,cw, ∆Ers, ∆Ecw, Est,rs, Est,L and Est,cw. Lateral and anteroposterior diameters increased significantly, with the exception of lateral diameters at the level of crista iliaca. Cephalocaudal diameter and FRC decreased.In conclusion, pneumoperitoneum augments elastances and increases the pressure dissipated against viscoelasticity/inhomogeneity of the respiratory system and chest wall. These changes are related to a cephalad displacement of the diaphragm plus changes in thoracoabdominal configuration.

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Section: Discussionsupporting

confidence: 71%

Section: Circumferences CMmentioning

confidence: 99%

mentioning

confidence: 99%

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Respiratory mechanics and morphometric changes during pneumoperitoneum in normal rats

Moreira

Gobbi²,

Feijoo³

et al. 1997

Eur Respir J

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“…The other systemic involvement in laparoscopic surgeries due to gas insufflation includes respiratory affection in the form of airway collapse, atelectasis, ventilation-perfusion mismatch, hypoxemia and hypercarbia [7] . Renal impairment in the form of reduced GFR may be seen.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Effect of Infusion of Dexmedetomidine on Attenuation of Hemodynamic Response During Laparoscopic Surgeries

Yennawar¹

2017

jmscr

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Diaphragm Function Is Not Impaired by Pneumoperitoneum After Laparoscopy

Benhamou

Simonneau²,

Poynard³

et al. 1993

Arch Surg

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Open cholecystectomy is known to induce a major restrictive respiratory syndrome. These respiratory disturbances, although of reduced magnitude, still persist after laparoscopic cholecystectomy. To determine the role of pneumoperitoneum per se in the respiratory dysfunction observed after this procedure, seven patients were studied before and 2 hours after laparoscopy. This diagnostic procedure avoids the upper midline incision and the surgical injury of cholecystectomy. Ventilatory performance and diaphragm function were assessed as follows: (1) during quiet tidal breathing by obtaining measurements of esophageal, gastric, and transdiaphragmatic pressures; determining the ratio of gastric pressures to esophageal pressures; and abdomen-rib cage partitioning of tidal volume obtained from two differential linear transformers and (2) during maximal respiratory efforts by obtaining measurements of vital capacity and maximal transdiaphragmatic pressure during Müller's maneuver and a sniff test. Although a large residual pneumoperitoneum (assessed as the maximal height of the suprahepatic space: Hmax = 30.3 +/- 7.8 mm) was observed after laparoscopy, we did not find any change suggestive of diaphragm dysfunction. We thus conclude that postoperative residual pneumoperitoneum per se is unable to explain the diaphragm dysfunction observed after open or laparoscopic cholecystectomy.

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Diaphragm Function and Pulmonary Complications After Laparoscopic Cholecystectomy

Cited by 7 publications

References 0 publications

Respiratory mechanics and morphometric changes during pneumoperitoneum in normal rats

Respiratory mechanics and morphometric changes during pneumoperitoneum in normal rats

Evaluation of Effect of Infusion of Dexmedetomidine on Attenuation of Hemodynamic Response During Laparoscopic Surgeries

Diaphragm Function Is Not Impaired by Pneumoperitoneum After Laparoscopy

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