Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?

El-Tahan, Mohamed R.; Dossary, Noha D. Al; Emam, Hatem El; Diab, Douaa G.; Al’Saflan, Abdulhadi; Zien, Haitham; Ahmadey, Mona Al; Deria, Afrah

doi:10.1007/s00464-011-1884-x

Cited by 5 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 26 ] Hypocapnia has been used to prevent surges of blood pressure due to CO 2 insufflation during laparoscopic cholecystectomy. [ 27 ] The present study has failed to confirm this beneficial effect of hypocapnia and, indeed, hypocapnia has been associated with higher incidences of increased intra-operative blood pressure compared with the non-hypocapnia groups, which may be due to the differences in the settings and the protocols of the two studies.…”

Section: Discussioncontrasting

confidence: 66%

Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

2014

View full text Add to dashboard Cite

Background:A retrospective study has shown lesser days of hospital stay in patients with increased levels of intra-operative end-tidal carbon dioxide (ETCO2). It is probable that hypercapnia may exert its beneficial effects on patients’ outcome through optimization of global hemodynamic and tissue oxygenation, leading to a lower rate of post-operative complications. This study was designed to test the hypothesis that higher values of intra-operative ETCO2 decrease the rate of post-operative complications.Materials and Methods:In this randomized, double-blind clinical trial, 78 adult patients scheduled for percutaneous nephrolithotomy (PCNL) were prospectively enrolled and randomly divided into three groups. ETCO2 was set and maintained throughout the procedure at 31-33, 37-39 and 43-45 mmHg in the hypocapnia, normocapnia and hypercapnia groups, respectively. The rates of post-operative complications were compared among the three groups.Results:Seventy-five patients completed the study (52 male and 23 female). Ten (38.5%), four (16%) and two (8.3%) patients developed post-operative vomiting in the hypocapnia, normocapnia and hypercapnia groups, respectively (P = 0.025). The nausea score was significantly lower in the hypercapnic group compared with the other groups (3.9 ± 1.8, 3.2 ± 2.1 and 1.3 ± 1.8 in the hypocapnia, normocapnia and hypercapnia groups, respectively; P = 0.000). Time to return of spontaneous respiration and awakening were significantly decreased in the hypercapnia group compared with the other groups (P < 0.01).Conclusion:Mild intra-operative hypercapnia has a protecting effect against the development of post-operative nausea and vomiting and decreases the duration of emergence and recovery from general anesthesia.

show abstract

Section: Discussioncontrasting

confidence: 66%

Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

2014

View full text Add to dashboard Cite

show abstract

“…CO 2 insufflation to create pneumoperitoneum during laparoscopy results in haemodynamic changes 5,8,29,30 . Our study adjusted ventilation to maintain end-tidal carbon dioxide between 4.6 and 5.3 kPa in both groups.…”

Section: Discussionmentioning

confidence: 98%

“…CO 2 insufflation to create pneumoperitoneum during laparoscopy results in haemodynamic changes. 5,8,29,30 Our study adjusted ventilation to maintain end-tidal carbon dioxide between 4.6 and 5.3 kPa in both groups. Consequently, changes in blood pressure induced by potential hypercarbia were unlikely and should be similar in both groups.…”

Section: Haemodynamic Eventsmentioning

confidence: 99%

“…4 CO 2 insufflation, to create pneumoperitoneum during laparoscopy, induces haemodynamic changes secondary to the increase in intra-abdominal pressure and the subsequent hormone release, even in the absence of hypercarbia. [5][6][7][8] These alterations in haemodynamic status may be misinterpreted as 'insufficient antinociception'. Consequently, opioids are sometimes administered unnecessarily with a risk of postoperative hyperalgesia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of pupillary reflex dilation-guided opioid administration on remifentanil and morphine consumption during laparoscopic surgery

Guerci

Jay

Arnout

et al. 2021

European Journal of Anaesthesiology

View full text Add to dashboard Cite

BACKGROUND Analysis of pupillary reflex dilation (PRD) assesses the balance of nociception--antinociception. Laparoscopic surgery induces haemodynamic variations that are misleading. During laparoscopy, PRD guidance helps differentiate haemodynamic changes because of excess nociception from secondary changes related to the reflex release of endocrine factors. OBJECTIVE The present study evaluated the effect of PRD-guided antinociception on the administration of intra-operative remifentanil and immediate postoperative morphine consumption in patients undergoing elective laparoscopic surgery. DESIGN The study was a single-blind, randomised controlled trial. SETTING The study took place at two sites at the University Hospital of Nancy from March 2014 to November 2017. PATIENTS A total of 100 patients who underwent scheduled laparoscopic surgery were included. INTERVENTIONS Patients were randomly given remifentanil guided by PRD (PRD-guided) or standard anaesthesia care (control). MAIN OUTCOME MEASURES The primary outcome was intra-operative remifentanil consumption. Secondary outcomes included morphine consumption in the immediate postoperative period and the number of intra-operative haemodynamic events. RESULTS Data from 95 patients were analysed. Intraoperative remifentanil consumption was lower in the PRD-guided group than in the control group: median [IQR], 0.09 [0.07 to 0.11] vs. 0.14 [0.12 to 0.16] μg kg−1 min−1, with a mean difference (95% confidence Interval, CI) of 0.048 (0.035 to 0.060) μg kg−1 min−1; P < 0.0001. Morphine consumption was 0.13 [0.1 to 0.5] vs. 0.15 [0.11 to 0.4] mg kg−1 (P = 0.52) in the PRD-guided and control groups, respectively. The number of hypertensive and tachycardia events was greater in the PRD-guided group than in the control group: Hypertensive events 60.4% vs. 32.6%, relative risk 1.85 (95% CI, 1.24 to 2.84), P = 0.004; tachycardia events 31.6% vs. 4.3%, relative risk 2.09 (95% CI, 1.45 to 2.84), P < 0.001. CONCLUSIONS When PRD is used to differentiate between haemodynamic events arising from noxious stimuli and those events because of other nonsurgical stimuli, then intra-operative remifentanil administration is reduced intra-operatively during laparoscopic surgery but there was no change in postoperative morphine consumption. TRIAL REGISTRATION Clinicaltrials.gov NCT02116868.

show abstract

“…Laparoscopic cholecystectomy, one of the most common surgeries in clinical practice, is usually performed under the condition of general anesthesia. The main reasons why CO 2 pneumoperitoneum can affect heart rate, blood pressure and other vital signs are: [9,10] CO 2 diffuses into the blood and stimulates the carotid body and the aortic chemoreceptors to generate pressor reflex; the mechanical extrusion of pneumoperitoneum on the intra-abdominal great vessels, leads to the obstruction of venous return along with higher pressure of aortic outflow tracts; upward movement of the diaphragm and decrease of respiratory compliance affect respiratory metabolism system and further enhance the retention of CO 2 in the body. At present, PC and VC modes are two main choices applied to the general anesthesia in laparoscopic surgeries, and they cannot satisfactorily ease the fluctuation of vital signs caused by pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Application of PRVC in laparoscopic surgery

Duan¹,

Huang

Hao

et al. 2017

DCC

View full text Add to dashboard Cite

Objective: To discuss the clinical significance and value of PRVC by monitoring, comparing and studying pressure control (PC), volume control (VC) and pressure-regulated volume control (PRVC) ventilation modes during pneumoperitoneum. Methods: Ninety patients with laparoscopic cholecystectomy were randomly and equally divided into 3 groups (PC group, VC group and PRVC group). Esophageal pressure (PES), mean airway pressure (PAWM), peak airway pressure (PAP), arterial blood carbon dioxide partial pressure (PaCO2), end-tidal carbon dioxide concentration in the expired air (ETCO2), tidal volume (TV), mean arterial pressure (MAP) and heart rate (HR) were not only detected before pneumoperitoneum, but also in 5, 10, 15 and 20 minutes after pneumoperitoneum. Results: PES after pneumoperitoneum in VC mode was obviously higher than that in PC and PRVC groups. In 10 minutes after pneumoperitoneum, levels of PaCO2 and ETCO2 became increased obviously in PC and VC groups (p < .05); levels of PaCO2 and ETCO2 were not only increased in PC group, but also the level of TV after pneumoperitoneum in PC group was significantly lower than that in the other two groups (p < .05). Levels of PaCO2 and ETCO2 were increased in PC and VC groups after pneumoperitoneum, along with the increase of MAP and HR (p < .05). After pneumoperitoneum, levels of MAP and HR in PRVC group were significantly lower than those in PC and VC groups (p < .05). Conclusions: PRVC mode can effectively reduce the pneumoperitoneum-induced increase of PAWM, PAP and PES without the unusual increase of PaCO2 and ETCO2 during surgery, so as to guarantee the stability of vital signs in perioperative patients.

show abstract

Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?

Abstract: The authors conclude that the use of hypocapnia before and during CO(2) insufflation is effective in attenuating increases in blood pressure after CO(2) pneumoperitoneum during anesthesia for laparoscopic cholecystectomy.

Cited by 5 publications

References 20 publications

Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

Effects of pupillary reflex dilation-guided opioid administration on remifentanil and morphine consumption during laparoscopic surgery

Application of PRVC in laparoscopic surgery

Contact Info

Product

Resources

About