Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients

被引:71
|
作者
Koivusalo, A. -M. [1 ]
Pere, P. [1 ]
Valjus, M. [1 ]
Scheinin, T. [2 ]
机构
[1] Univ Helsinki, Dept Anaesthesia & Intens Care, SF-00100 Helsinki, Finland
[2] Helsinki Univ Cent Hosp, Dept Gastroenterol & Gen Surg, Helsinki 00290, Finland
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2008年 / 22卷 / 01期
关键词
cholecystectomy; CO2; pneumoperitoneum;
D O I
10.1007/s00464-007-9300-2
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Because of absorbed carbon dioxide (CO2) and elevated intraabdominal pressure (IAP), CO2 pneumoperitoneum (CO2PP) has potentially harmful intraoperative circulatory and ventilatory effects. Although not clinically significant for healthy patients, these effects are assumed to be deleterious for patients with a high risk for anesthesia (American Society of Anesthesiology [ASA] 3 and 4) and significant cardiopulmonary, renal, or hepatic diseases. The authors assessed CO2PP-related adverse effects by comparing ASA 3 and 4 patients who underwent laparoscopic cholecystectomy (LC) with or without CO2PP. Methods: A total of 20 successive ASA 3 and 4 patients who underwent LC were randomized into CO2PP (n = 10) and abdominal wall elevator (Laparolift) (n = 10) groups. The parameters for perioperative hemodynamics, ventilation, perfusion of intraabdominal organs, and blood chemistry were recorded periodically from before the induction of the anesthesia until postoperative day 2 and compared between the groups. Results: Mean age, height, weight, the proportional number of ASA 3 vs ASA 4 patients, the volume of perioperative fluid loading, and the dose of analgesics did not differ significantly between the groups. The length of the operation was 49.9 +/- 10.6 min for the CO2PP group and 50.6 +/- 17.2 min for Laparolift group (nonsignificant difference). The mean central venous pressure (CVP) 30 min after insufflation was higher (12.3 +/- 4.8 vs 7.9 +/- 3.7 mmHg) and the (Gastric Mucosal pH) pHi at the end of the operation was lower (7.29 +/- 0.07 vs 7.35 +/- 0.04) in the CO2PP group than in the Laparolift group (p < 0.05). Later, CVP and pHi did not di. er significantly. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry did not differ significantly. Conclusions: For LC for patients with an ASA 3 and 4 risk for anesthesia, no significant adverse effects could be attributed to CO2 pneumoperitoneum. For high-risk patients, preoperative preparation and active perioperative monitoring are essential for safe anesthesia for LC with or without CO2PP.
引用
收藏
页码:61 / 67
页数:7
相关论文
共 50 条
  • [31] CARBON-DIOXIDE, TEMPERATURE AND LAPAROSCOPIC CHOLECYSTECTOMY
    MONAGLE, J
    BRADFIELD, S
    NOTTLE, P
    AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 1993, 63 (03): : 186 - 189
  • [32] Is Laparoscopic Bariatric Surgery a Safe Option in Extremely High-Risk Morbidly Obese Patients?
    Aminian, Ali
    Jamal, Mohammad H.
    Andalib, Amin
    Batayyah, Esam
    Romero-Talamas, Hector
    Chand, Bipan
    Schauer, Phillip R.
    Brethauer, Stacy A.
    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, 2015, 25 (09): : 707 - 711
  • [33] Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum
    Schmandra, TC
    Mierdl, S
    Bauer, H
    Gutt, C
    Hanisch, E
    BRITISH JOURNAL OF SURGERY, 2002, 89 (07) : 870 - 876
  • [34] The laparoscopic cholecystectomy is safe in patients with liber cirrhosis?
    Bernardo, Wanderley Marques
    Aires, Felipe Toyama
    REVISTA DA ASSOCIACAO MEDICA BRASILEIRA, 2011, 57 (04): : 367 - 368
  • [35] Laparoscopic Cholecystectomy in Patients on Clopidogrel-Is It Safe?
    Frazee, Richard
    Abernathy, Stephen
    GASTROENTEROLOGY, 2013, 144 (05) : S1067 - S1067
  • [36] Splanchnic and renal deterioration during and after laparoscopic cholecystectomy: A comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method
    Koivusalo, AM
    Kellokumpu, I
    Ristkari, S
    Lindgren, L
    ANESTHESIA AND ANALGESIA, 1997, 85 (04): : 886 - 891
  • [37] CHANGES IN CARBON-DIOXIDE (CO2) STORES DURING LAPAROSCOPIC CHOLECYSTECTOMY WITH CO2 PNEUMOPERITONEUM
    WURST, H
    SCHULTESTEINBERG, H
    FINSTERER, U
    ANAESTHESIST, 1995, 44 (03): : 147 - 153
  • [38] Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration
    Li, Li-Wei
    Zhang, Wei
    Ai, Yan-Qiu
    Li, Li
    Peng, Zhou-Quan
    Wang, Hong-Wei
    JOURNAL OF INTERNATIONAL MEDICAL RESEARCH, 2013, 41 (03) : 889 - 894
  • [39] Is screening mammography safe for high-risk patients?
    Benson, John
    LANCET ONCOLOGY, 2006, 7 (05): : 360 - 362
  • [40] LAPAROSCOPIC CHOLECYSTECTOMY IN HIGH-RISK PATIENTS - A RANDOMIZED COMPARISON BETWEEN EPIDURAL ANALGESIA AND GENERAL-ANESTHESIA
    SABATE, A
    BIESCAS, J
    VILA, C
    ALEMANY, O
    BRITISH JOURNAL OF ANAESTHESIA, 1995, 74 : 53 - 53