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Anesth Analg 2000;90:466
© 2000 International Anesthesia Research Society

GENERAL ARTICLES

Inert Gas Exchange During Pneumoperitoneum at Incremental Values of Positive End-Expiratory Pressure

Alexander Loeckinger, MD, Axel Kleinsasser, MD, Christoph Hoermann, MD Anette Krismer, MD, Michael Gassner, MD, Christian Keller, MD Friedrich Puehringer, MD, and Karl H. Lindner, MD

Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Innsbruck, Austria

Address correspondence and reprint requests to Dr. Alexander Loeckinger, The Leopold-Franzens-University of Innsbruck, Department of Anesthesiology and Critical Care Medicine, Anichstr. 35, 6020 Innsbruck, Austria. Address e-mail to alex.loeckinger{at}uibk.ac.at

Laparoscopy is a surgical technique for a growing variety of abdominal operations. In patients undergoing this procedure, arterial blood oxygenation and hemodynamics are frequently depressed. This study evaluated the effect of different levels of positive end-expiratory pressure (PEEP) during intraperitoneal CO2 insufflation on the lung’s ventilation-perfusion distribution in a porcine model. We studied 13 anesthetized pigs with an intraperitoneal pressure of 15 cm H2O applied at either incremental values of PEEP (5–20 cm H2O, increments of 5 cm H2O) or a constant PEEP of 5 cm H2O. The effects of CO2 pneumoperitoneum on inert gas exchange and hemodynamics were examined with the multiple inert gas elimination technique. During pneumoperitoneum, gas exchange was most augmented by 15 and 20 cm H2O of PEEP. Although the differences in hemodynamics between the individual settings were insignificant, 10 cm H2O of PEEP provided the smallest impairment of hemodynamics. We conclude that PEEP of 15 H2O during pneumoperitoneum resulted in a modest hemodynamic depression but significant gas exchange augmentation in our experiment.

Implications: Anesthetized pigs, with a pneumoperitoneum of 15 cm H2O, were treated either with incremental values of positive end-expiratory pressure (5–20 cm H2O, increments of 5 cm H2O) or with a constant positive end-expiratory pressure of 5 cm H2O. Fifteen and 20 cm H2O resulted in significantly improved pulmonary gas exchange compared with 5 cm H2O.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2000 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2000 by the International Anesthesia Research Society.