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
  • [41] Pulmonary carbon dioxide embolism during laparoscopic cholecystectomy
    Ishiyama, T
    Hanagata, K
    Kashimoto, S
    Kumazawa, T
    CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 2001, 48 (03): : 319 - 320
  • [42] CARBON-DIOXIDE EMBOLISM DURING LAPAROSCOPIC CHOLECYSTECTOMY
    MOSKOP, RJ
    LUBARSKY, DA
    SOUTHERN MEDICAL JOURNAL, 1994, 87 (03) : 414 - 415
  • [43] Warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy
    Jacobs, VR
    Morrison, JE
    SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, 2001, 15 (10): : 1244 - 1245
  • [44] Management of acute calculous cholecystitis in high-risk patients -: Percutaneous cholecystotomy followed by early laparoscopic cholecystectomy
    Akyürek, N
    Salman, B
    Yüksel, O
    Tezcaner, T
    Irkörücü, O
    Yücel, C
    Oktar, S
    Tatlicioglu, E
    SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, 2005, 15 (06): : 315 - 320
  • [45] Pulmonary carbon dioxide embolism during laparoscopic cholecystectomy
    Tadahiko Ishiyama
    Kazuyuki Hanagata
    Satoshi Kashimoto
    Teruo Kumazawa
    Canadian Journal of Anesthesia, 2001, 48 : 319 - 320
  • [46] Warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy
    V. R. Jacobs
    J. E. Morrison
    Surgical Endoscopy, 2001, 15 : 1244 - 1245
  • [47] A study of laparoscopic colectomy for high-risk patients
    Yaginuma, Y.
    Tashiro, Y.
    Nagayasu, K.
    Niwa, K.
    Ono, S.
    Ishiyama, S.
    Sugimoto, K.
    Hata, M.
    Kamiyama, H.
    Komiyama, H.
    Takahashi, M.
    Kojima, Y.
    Goto, M.
    Tanaka, M.
    Sengoku, H.
    Okuzawa, A.
    Tomiki, Y.
    Sakamoto, K.
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2010, 25 : A176 - A176
  • [48] Is laparoscopic cholecystectomy a safe alternative to open cholecystectomy for pediatric patients with cholelithiasis?
    Simi, M
    Schietroma, M
    Carlei, F
    Iannucci, D
    Cianca, G
    Leardi, S
    ENDOSCOPY, 1996, 28 (03) : 312 - 315
  • [49] Pneumoperitoneum versus laparolift; effects on central circulation in laparoscopic cholecystectomy patients
    Andersson, L
    Bringman, S
    Ramel, S
    Anderberg, B
    Lindberg, G
    Sollevi, A
    Odeberg-Wernerman, S
    BRITISH JOURNAL OF ANAESTHESIA, 1999, 82 : 55 - 55
  • [50] Is "Hot" Laparoscopic Cholecystectomy in patients with high BMI a safe option?-Outcomes of Emergency Laparoscopic Cholecystectomy in obese vs non-obese patients
    Bezzaa, Sabrina
    Patel, Reeya
    Boven, Carine
    Gerogiannis, Ioannis
    BRITISH JOURNAL OF SURGERY, 2022, 109