Effects of pneumoperitoneum on the amplitude of diaphragmatic excursion in pigs

Changes in diaphragmatic excursion and lung compliance during gynaecologic surgery: open laparotomy versus laparoscopy-a prospective observational study

This study compared the effects of open versus laparoscopic radical hysterectomy on intraoperative diaphragmatic excursion and lung compliance. We enrolled 20 women per group; Group O’s members underwent open radical hysterectomy, while Group L’s members underwent laparoscopic radical hysterectomy. Diaphragmatic excursion was measured by assessing tidal ventilation using M-mode ultrasonography before intubation (T0), after intubation with mechanical ventilation (T1), 90 min after incision (T2), and at the end of the operation with recovery of muscle relaxation (T3). Peak inspiratory pressure and static lung compliance were measured using an anaesthesia machine combined with a ventilator. Diaphragmatic excursion was significantly lower in Group L than in Group O at T2 (5.3 ± 1.7 mm vs. 7.7 ± 2.0 mm, P < 0.001) and T3 (8.4 ± 1.9 vs. 10.4 ± 2.4, P = 0.011). Impaired diaphragmatic excursion at T3 (< 10 mm under mechanical ventilation) occurred in 15 patients (83.3%) in Group L and seven (38.9%) in Group O (P = 0.006). Changes over time in peak inspiratory pressure and static lung compliance differed significantly between the two groups (P < 0.001 each). Laparoscopic radical hysterectomy decreased diaphragmatic excursion and static lung compliance significantly more than open radical hysterectomy.

Korean clinical trial number: Korean Clinical Trials Registry (KCT0004477) (Date of registration: November 18 2019) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14963&ltype=&rtype=).

Changes of diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery: A prospective observational study

Major laparoscopic pelvic surgery requires steep Trendelenburg position with pneumoperitoneum for a long time. We investigated the effect of Trendelenburg position with pneumoperitoneum on diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery using M-mode sonography. Twenty patients undergoing elective pelviscopic radical hysterectomy were included in this study. Diaphragmatic excursion was measured at the following time points; after sedation, after intubation, 90 minutes after Trendelenburg position with pneumoperitoneum, and after operation with recovery of muscle relaxation. And lung compliance was measured using anesthetic machine under general anesthesia; after the intubation, 90 minutes after Trendelenburg position with pneumoperitoneum and after operation with recovery of muscle relaxation. In order to detect postoperative pulmonary complication, postoperative chest radiography was checked. Static lung compliance, dynamic lung compliance and diaphragmatic excursion were decreased during operation (P < 0.001, respectively). At the end of the operation with recovery of muscle relaxation, reduced diaphragmatic movement was not recovered as its excursion after sedation (P < 0.001). In conclusion, lung compliance was decreased following transiently decreased diaphragmatic excursion during major laparoscopic pelvic surgery.

Cardiorespiratory evaluation in pre and post operative moments of laparoscopic cholecystectomy

PURPOSE

To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy.

METHODS

Fifty patients were evaluated (76% women) and the average age was 47.8 ± 14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days.

RESULTS

BMI average was 28.8 ± 4.8 kg/m(2). Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers. There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE.

CONCLUSION

Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions.

Improved ventilation-perfusion matching with increasing abdominal pressure during CO(2) -pneumoperitoneum in pigs

BACKGROUND

CO(2) -pneumoperitoneum (PP) is performed at varying abdominal pressures. We studied in an animal preparation the effect of increasing abdominal pressures on gas exchange during PP.

METHODS

Eighteen anaesthetized pigs were studied. Three abdominal pressures (8, 12 and 16 mmHg) were randomly selected in each animal. In six pigs, single-photon emission computed tomography (SPECT) was used for the analysis of V/Q distributions; in another six pigs, multiple inert gas elimination technique (MIGET) was used for assessing V/Q matching. In further six pigs, computed tomography (CT) was performed for the analysis of regional aeration. MIGET, CT and central haemodynamics and pulmonary gas exchange were recorded during anaesthesia and after 60 min on each of the three abdominal pressures. SPECT was performed three times, corresponding to each PP level.

RESULTS

Atelectasis, as assessed by CT, increased during PP and in proportion to abdominal pressure [from 9 ± 2% (mean ± standard deviation) at 8 mmHg to 15 ± 2% at 16 mmHg, P<0.05]. SPECT during increasing abdominal CO(2) pressures showed a shift of blood flow towards better ventilated areas. V/Q analysis by MIGET showed no change in shunt during 8 mmHg PP (9 ± 1.9% compared with baseline 9 ± 1.2%) but a decrease during 12 mmHg PP (7 ± 0.9%, P<0.05) and 16 mmHg PP (5 ± 1%, P<0.01). PaO(2) increased from 39 ± 10 to 52 ± 9 kPa (baseline to 16 mmHg PP, P<0.01). Arterial carbon dioxide (PCO(2) ) increased during PP and increased further with increasing abdominal pressures.

CONCLUSION

With increasing abdominal pressure during PP perfusion was redistributed more than ventilation away from dorsal, collapsed lung regions. This resulted in a better V/Q match. A possible mechanism is enhanced hypoxic pulmonary vasoconstriction mediated by increasing PCO(2) .

Provas de função pulmonar no pré e pós-operatório de redução gastrica por celiotomia ou por videolaparoscopia

OBJETIVO: avaliar a função pumonar no pré e pós-operatório de indivíduos submetidos a redução gastrica por celiotomia(GC) ou videolaparoscopia(GV). MÉTODO: No período de Outubro de 2004 a outubro de 2005, foram submetidos à gastroplastia por Y de Roux 17 pacientes abordados por celiotomia e 20 pacientes abordados por videolaparoscopia . Nesses pacientes foram realizados espirometria , oximetria de pulso e monitorização da frequência respiratória(FR) antes e após a cirurgia até a 30ª hora e avaliação da dor pela escala visual analógia modificada no momento da espirometria. RESULTADOS: No préoperatório, todos os pacientes apresentaram provas de função pulmonar normais. Observou-se que do pré para o pós-operatório houve redução média significativa de 38,5% CFV, 39,1% VEF1 e 37% do PEF no Grupo GC e redução também significativa de 38,3% de CVF, 35,5% de VEF1 e 41,5% de PEF no Grupo GV. A FR apresentou aumento médio com significância estatistica de 16,9 %e 14,7% respectivamente nos Grupos GC e GV. O tempo cirúrgico foi de 179±17,7 para o grupo GC e 163,4±14,5 para o Grupo GV e os scores de dor 3,5±1,2 e 3,4±1,5 para GC e GV respectivamente. A incidência de complicações pós-operatórias foi de 2%%. CONCLUSÃO: concluímos que indivíduos do nosso estudo com obesidade grau II ou III apresentaram espirometrias normais e que ao se submeterem a gastroplastia pela técnica de Capella por celiotomia ou videolaparoscopia, apresentaram um padrão espirométrico de restrição pulmonar no pós-operatório imediato.