Pathophysiological and clinical aspects of the CO2 pneumoperitoneum (CO2-PP)

Abstract

Experimental studies demonstrated a severe cardiac load of the CO2 pneumoperitoneum caused by an accelerated after- and a decreased preload. Patients displaying cardiovascular risks are therefore often rejected from laparoscopic surgery. Hence, the pathophysiological changes and the intraoperative risk of the CO2 pneumoperitoneum in high-risk cardiopulmonary patients (NYHA II-III, n = 15) undergoing laparoscopic cholecystectomy are described. The changes in cardiac after- and preload seem to be due to the elevated intraabdominal pressure rather than transperitoneally resorbed CO2 and are reversible by desufflation. In one patient conversion to open operation had to be performed because of a severe drop in cardiac output and right ventricle ejection fraction. Mixed oxygen saturation was predicting intraoperative worsening in this case. The described pathophysiological changes may seem to be well tolerated even in high-risk cardiac patients. Monitoring of hemodynamics should include an arterial catheter line and blood gas analyses. Pharmacologic interventions or pressureless laparoscopic procedures might not be necessary as long as laparoscopic cholecystectomy is performed.

Laparoscopic Cholecystectomy under Spinal Anaesthesia: A Prospective Study

“…[9,10] This carboxemia induces metabolic and respiratory acidosis which decreases arterial and mixed venous pH and arterial pO 2 . [11,12] In our study we noticed that the SpO 2 remained within normal limits for the patients undergoing LC under SA. Retention of CO 2 and hypoxemia were not observed in the spinal anaesthesia group during the procedure.…”

RETRACTED ARTICLE: Different anesthesia methods for laparoscopic cholecystectomy

“…In the general anesthesia group it was necessary to introduce adequate ventilatory parameters while none of the patients in the spinal anesthesia group had any complaints and this difference was significant. It was necessary to increase the pneumoperitoneum pressure to 12 …”

“…Usually CO 2 is used for safety due to its high water solubility and its high capacity of exchange in the lungs. The concentration of CO 2 can be easily monitored by capnography and controlled by ventilation [12]. Pneumoperitoneum induces systemic effects due to the absorption of CO 2 , and in venous return due to the increase in intra-abdominal pressure [13].…”

“…Initially, absorption of CO 2 increases its elimination in the expired air, in the arterial and venous blood [13,14]. This carboxemia induces metabolic and respiratory acidosis decreasing arterial and mixed venous pH and arterial partial oxygen pressure (p a O 2 ; [12,14]). Absorption of CO 2 negatively affects the respiratory function [15], which is not observed with inert gases such as helium and argon.…”

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

“…May be hence, there is considerable reticence among surgeons in performing laparoscopy in patients with compromised heart. However, laparoscopic cholecystectomy has been successfully performed in small series of 10 [22, 23] -14 patients [24] with ASA III/IV cardiac dysfunction. To avoid the complications of pneumoperitoneum, gasless laparoscopic cholecystectomy (abdominal wall lifting) has been used as an alternative to laparoscopy in high risk patients [25].…”