Does hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring

Effect of carbon dioxide pneumoperitoneum on acid-base balance during laparoscopic inguinal hernia repair: a prospective randomized controlled study

BACKGROUND

In this study, we aimed to compare the effects of CO₂ pneumoperitoneum on acid-base balance during transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) procedures for repair of inguinal hernias.

METHODS

The study cohort comprised 100 patients who underwent repair of primary inguinal hernias from 1 June to 30 November 2019. The patients were randomly allocated to TAPP and TEP groups. Their acid-base balance was analyzed by comparing the results of blood gas analysis before and after the operative procedures and dynamic transcutaneous CO₂ (TcCO₂₎ changes during the procedures.

RESULTS

There were no statistically significant differences among groups in demographics, including sex, age, and hernia type. There were also no significant differences between the two groups in anesthesia time, incidence of perioperative complications, or type of management of the hernia sac (all P > 0.05). The operation time was shorter for the TEP than the TAPP group (P < 0.01). In terms of CO₂ metabolism and acid-base balance, the following differences between the two groups were statistically significant: changes in PaCO₂ (7.54 ± 3.36 vs. 20.36 ± 7.60 mmHg, P < 0.01), changes in TcCO₂ (8.86 ± 3.57 vs. 17.40 ± 8.03 mmHg, P < 0.01), rate of change in TcCO₂ (0.22 ± 0.11 vs. 1.03 ± 0.56, P < 0.01), and changes in pH (- 0.05 ± 0.28 vs. - 0.15 ± 0.76, P < 0.01).

CONCLUSION

TAPP and TEP can achieve good results in the treatment of inguinal hernia. Although no serious complications occurred, TEP procedures may cause more serious CO₂ accumulation and quicker acidosis than TAPP procedures.

Anaesthesia for laparoscopic nephrectomy: Does end-tidal carbon dioxide measurement correlate with arterial carbon dioxide measurement?

Background and Aims:

Not many studies have explored the correlation between arterial carbon dioxide tension (PaCO₂) and end-tidal carbon dioxide tension (ETCO₂) in surgeries requiring pneumoperitoneum of more than 1 hour duration with the patient in non-supine position. The aim of our study was to evaluate the correlation of ETCO₂ with PaCO₂ in patients undergoing laparoscopic nephrectomy under general anaesthesia.

Methods:

A descriptive study was performed in thirty patients undergoing laparoscopic nephrectomy from September 2014 to August 2015. The haemodynamic parameters, minute ventilation, PaCO₂ and ETCO₂ measured at three predetermined points during the procedure were analysed. Correlation was checked using Pearson's Correlation Coefficient Test. P <0.05 was considered statistically significant.

Results:

Statistical analysis of the values showed a positive correlation between ETCO₂ and PaCO₂ (P < 0.05). Following carbon dioxide insufflation, both ETCO₂ and PaCO₂ increased by 5.4 and 6.63 mmHg, respectively, at the end of the 1^st hour. The PaCO₂-ETCO₂ gradient was found to increase during the 1^st hour following insufflation (4.07 ± 2.05 mmHg); it returned to the pre-insufflation values in another hour (2.93 ± 1.43 mmHg).

Conclusion:

Continuous ETCO₂ monitoring is a reliable indicator of the trend in arterial CO₂ fluctuations in the American Society of Anesthesiologists Grades 1 and 2 patients undergoing laparoscopic nephrectomy under general anaesthesia.

Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

Background

Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO₂) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system.

Methods

A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO₂), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO₂ insufflation, and 30 min after desufflation.

Results

CO₂ insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO₂ insufflation pressure caused increases in PaCO₂ and decreases in arterial pH. However, vital signs were stable and pH and PaCO₂ were within the physiologic range during the surgery in the 6- and 9-mmHg groups.

Conclusions

We propose that a CO₂ insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.

Complications of laparoscopic inguinal herniorrhaphy including one case of atypical mycobacterial infection

BACKGROUND

Although laparoscopic inguinal herniorrhaphy is considered safe, several complications may occur. This study aimed to evaluate the complications observed in 780 laparoscopic inguinal herniorrhaphies at the authors' hospital.

METHODS

All the patients who underwent laparoscopic inguinal herniorrhaphy at the authors' hospital during a period of 11 years were enrolled retrospectively in this study. Patient demographics, operative data, and intra- and postoperative complications were evaluated.

RESULTS

A total of 569 patients underwent 780 laparoscopic inguinal herniorrhaphies. The male-to-female ratio was 8.8 to 1, and the mean age was 54.8 ± 15.7 years. Hernia recurrence was recognized in 14 patients (2.5%). Intra- and postoperative complications were diagnosed in 28 (4.9%) and 35 (6.2%) patients respectively. There was no mortality. The most common intraoperative complication was extensive subcutaneous emphysema. Two patients with extensive subcutaneous emphysema had cardiac arrhythmia. Small bowel perforation and bladder perforation occurred in one patient each. One patient had extensive preperitoneal infection caused by Mycobacterium massiliense, which required mesh removal, tissue debridement, and prolonged antibiotic therapy.

CONCLUSIONS

Although the mortality rate is low, potentially life-threatening complications such as small bowel and bladder perforation may be experienced by patients subjected to laparoscopic herniorrhaphy.

Effects of Intraperitoneal and Extraperitoneal Carbon Dioxide Insufflation on Blood Gases During the Perioperative Period

The aim of this study was to evaluate the effects of intraperitoneal and extraperitoneal CO2 insufflation on blood gases during and after laparoscopic surgery. Forty patients were included in this study. Twenty patients underwent elective laparoscopic cholecystectomy with intraperitoneal insufflation (intraperitoneal group) and 20 patients underwent laparoscopic inguinal hernia repair with extraperitoneal insufflation (extraperitoneal group). Arterial blood gases were analyzed at four points: 10 minutes after induction, 10 minutes after insufflation, 10 minutes after desufflation, and 30 minutes after the operation in the recovery room. PaCO2 values in the intraperitoneal group at the four points were 36.8 +/- 4, 39.6 +/- 5.9, 40.7 +/- 4.4, and 42.3 +/- 4.8 mm Hg; in the extraperitoneal group, 35.8 +/- 3.9, 37.4 +/- 4, 42.8 +/- 6.6, and 46.2 +/- 5.9 mm Hg. In the extraperitoneal group, there was a significant increase in postoperative PaCO2 compared to the desufflation PaCO2. In our study, extraperitoneal CO2 insufflation caused increases in PaCO2 values that started perioperatively and continued in the postoperative period.