Impact of Extraperitoneal Dioxyde Carbon Insufflation on Respiratory Function in Anesthetized Adults: A Preliminary Study Using Electrical Impedance Tomography and Wash-out/Wash-in Technic

Abstract

Background:Extraperitoneal laparoscopy has become a common technique for many surgical procedures, especially for inguinal hernia surgery. Investigations of physiological changes occurring during extraperitoneal carbon dioxide (CO2) insufflation mostly focused on blood gas changes. To date, the impact of extraperitoneal CO2 insufflation on respiratory mechanics remains unknown, whereas changes in respiratory mechanics have been extensively studied in intraperitoneal insufflation.Objectives:The aim of this study was to investigate the effects of extraperitoneal CO2 insufflation on respiratory mechanics.Patients and Methods:A prospective and observational study was performed on nine patients undergoing laparoscopic inguinal hernia repair. Anesthetic management and intraoperative care were standardized. All patients were mechanically ventilated with a tidal volume of 8 mL/kg using an Engström Carestation ventilator (GE Healthcare). Ventilation distribution was assessed by electrical impedance tomography (EIT). End-expiratory lung volume (EELV) was measured by a nitrogen wash-out/wash-in method. Ventilation distribution, EELV, ventilator pressures and hemodynamic parameters were assessed before extraperitoneal insufflation, and during insufflation with a PEEP of 0 cmH2O, 5 cmH20 and of 10 cmH20.Results:EELV and thoracopulmonary compliance were significantly decreased after extraperitoneal insufflation. Ventilation distribution was significantly higher in ventral lung regions during general anesthesia and was not modified after insufflation. A 10 cmH20 PEEP application resulted in a significant increase in EELV, and a shift of ventilation toward the dorsal lung regions.Conclusions:Extraperitoneal insufflation decreased EELV and thoracopulmonary compliance. Application of a 10 cmH20 PEEP increased EELV and homogenized ventilation distribution. This preliminary clinical study showed that extraperitoneal insufflation worsened respiratory mechanics, which may justify further investigations to evaluate the clinical impact.

Assessment of Ventilation Distribution during Laparoscopic Bariatric Surgery: An Electrical Impedance Tomography Study

“…On the contrary, the observed reduction in Impedance Ratio (IR) suggests more homogenous ventilation distribution. In the previously mentioned studies by He et al [13] and Bordes et al [15] pneumoperitoneum did cause more atelectasis and a ventral shift of ventilation. Karsten et al [12] however also reported no additional ventilation shift during 15 mmHg pneumoperitoneum for laparoscopic cholecystectomy in patients ventilated without PEEP.…”

“…Reports on intraoperative use of EIT for ventilation assessment are scarce [8, 12–15]. Schaefer et al [8] pointed out that EIT monitoring during abdominal surgery has significant limitations.…”

“…It should be noted that the studies by Karsten et al [12] and He et al [13] which were also conducted during abdominal laparoscopic surgery did not report on any technical problems even though the belt was placed between the 5th and 6th intercostal space. On the other hand Radke et al [14] used EIT during orthopaedic surgery and Bordes et al [15] during extraperitoneal laparoscopy for inguinal hernia repair. In both cases belt location did not interfere with the surgical site.…”

Comparison of Positive End-Expiratory Pressure versus Tidal Volume-Induced Ventilator-Driven Alveolar Recruitment Maneuver in Robotic Prostatectomy: A Randomized Controlled Study

“…However, when we considered radiation exposure, time, and cost, CT was precluded. To measure changes in EELV, nitrogen wash-out might be an alternative method [27]. However, this measurement is technically challenging and prone to error intraoperatively.…”

Changes in respiratory mechanics during extraperitoneal insufflation in inguinal hernia surgery

“…They also observed that end-expiratory lung volume increased during application of 10 cmH 2 O PEEP which also homogenised ventilation distribution. [ 7 ]…”