Title: Effects of Hyperventilation on Haemodynamics, Partial Pressure of Carbon Dioxide and Acid Base Status in Laparoscopic Surgeries-Randomized Control Study

Authors: Dr Saravana Kumar S, Dr Gayathri B, Dr Bhavani Vaidiyanathan

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i9.106

Abstract

The aim of the study was to compare the effects of hyperventilation on haemodynamics and partial pressure of carbon dioxide and acid base status with three different respiratory rates and tidal volume of 10 ml /kg .

Methods: 90 patients undergoing laparoscopic surgeries under General Anaesthesia were randomized into three groups, with tidal volume of 10 ml/kg and respiratory rate of 12,14,16 per  minute. Hemodynamic variables (heart rate and mean arterial pressure) were recorded and End tidal C02, PaC02, pH and Bicarbonate estimation done before, during and after C02 pneumoperitoneum.

Results: The three groups were similar in demographic profile.There were no significant difference in mean arterial pressure before creation of pneumoperitoneum in all three groups. (p value 0.067). Arterial blood gas analysis demonstrated higher PaCO2 and lower pH in control group than in study group. PaCO2 values measured before pneumoperitoneum showed a higher value in group 1 whereas  it was lower in normal range in groups 2 and 3 .The values were 34.92 mm of Hg and 33.13 mm of Hg respectively and  statistically significant (p value is 0.0000).  Heart rate was significantly higher in the control group than the study groups during pneumoperitoneum Peak inspiratory pressure did not suffer significantly between the groups  and the p value was 0.976. During the pneumoperitoneum the groups 2 and 3  showed a significantly higher values than the group 1 ( p  0.000.)

Conclusions: During laparoscopic surgeries and increasing the minute ventilation by increasing the respiratory rate from 12 per minute to 14 per minute  produces a significant decrease in partial pressure of carbon  dioxide ,end tidal carbon dioxide and pH .

Keywords: respiratory rate, laparoscopic surgeries, hyperventilation.

References

  1. Iqbal A, Mujoo S, Saleem B, Hameed A. Effects of Co2 Pneumoperitoneum in Patients Undergoing Short Laparoscopic Gynaecology Procedures. IOSR J Dent Med Sci [Internet]. 2016 [cited 2017 Sep 8];15:2279–861. Available from: www.iosrjournals.org
  2. Hunter JG. Advanced laparoscopic surgery. Am J Surg. 1997;173(1):14–20.
  3. Périssat J, Collet D, Monguillon N. Advances in laparoscopic surgery. Digestion. 1998. p. 606–18.
  4. Lindgren L, Koivusalo a M, Kellokumpu I. Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy. Br J Anaesth [Internet]. 1995;75(5):567–72. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7577282
  5. Chui PT, Gin T, Oh TE. Anaesthesia for laparoscopic general surgery. Anaesthesia and Intensive Care. 1993. p. 163–71.
  6. Maharjan SK, Shrestha BR. Do we have to hyperventilate during laparoscopic surgery? Kathmandu Univ Med J. 2007;5(19):307–11.
  7. Gupta R, Singh S. Challenges in paediatric laparoscopic surgeries. Indian J Anaesth [Internet]. 2009;53(5):560–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2900088&tool=pmcentrez&rendertype=abstract
  8. Ibrahim M, Raga A, ElShama H. I-gel vs cuffed tracheal tube during volume controlled ventilation in elective laparoscopic cholecystectomy. Egypt J Anaesth. 2011;27(1):7–11.
  9. Das M, Ray M, Mukherjee G. HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY : EFFECT OF CLONIDINE PREMEDICATIONDas, M., Ray, M., & Mukherjee, G. (2007). HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY : EFFECT OF CLONIDINE PREMEDICATION, 51(3), 205–210. 2007;51(3):205–10.
  10. Leonard IE, Cunningham AJ. Anaesthetic considerations for laparoscopic cholecystectomy. Best Practice and Research: Clinical Anaesthesiology. 2002. p. 1–20.

Corresponding Author

Dr Gayathri B

Assistant Professor, Department of Anaesthesiology

Stanley Medical College & Hospital Chennai-1