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CURRENT ISSUEGAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

A Journal on Internal Medicine and Pharmacology


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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 January-February;172(1-2):11-19

 ORIGINAL ARTICLES

The effects of the positive end expiratory pressure during laparoscopic cholecystectomy on postoperative respiratory function: a randomized controlled trial

Ozkardesler Birlik S. 1, Akan M. 1, Atila K. 2, Sevinc C. 3, Ozzeybek D. 1, Tasdogen A. 1, Duran E. 4, Elar Z. 1

1 Department of Anesthesiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey;
2 Department of General Surgery, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey;
3 Department of Pulmology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey;
4 Department of Anesthesiology, Sehit Kamil State Hospital, Gaziantep, Turkey

Aim: The aim of the present study was to investigate the effects of 8 cm H2O of positive end expiratory pressure (PEEP) with pneumoperitoneum (PP) of 14 mmHg on respiratory system mechanics and function in addition to oxygenation during and after laparoscopic cholecystectomy.
Methods: In this prospective study, 70 ASA physical status I-II patients undergoing laparoscopic cholecystectomy were randomized equally to ventilate with 8 cm H2O of PEEP (Group 1) or 0 cm H2O of PEEP (Group 2) during PP. We determined tidal volume (VT), peak inspiratory pressure (PIP), mean airway pressure and dynamic pulmonary compliance (Cdyn) in the intraoperative period. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), the relation of the FEV1 to the FVC (FEV1 / FVC) and forced expiratory flow in the midexpiratory phase (FEF25-75%) were determined by using spirometry before and two hours after surgery.
Results: In Group 2, Cdyn was significantly lower compared to Group 1 at measurement times of C-14 and C-20 (P<0.05; P<0.01, respectively) but there was no significant difference after desufflation. The ratios of target FEV1 values at the second postoperative hour were 74.19% in Group 1 and 35.71% in Group 2 (χ2 test:7.35; P=0.0067). When the spirometry was repeated at the 24th postoperative hour for the patients that could not achieve target FEV1 values, it was determined that 77.41% of Group 1 and 53.57% of Group 2 (χ2 test:2.75; P=0.0975) achieved the target values.
Conclusion: This study shows that the PEEP of 8 cmH2O in laparoscopic cholecystectomy improves postoperative respiratory function in addition to significant improvement in Cdyn during pneumoperitoneum.

language: English


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