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AMBULATORY ANESTHESIA

Carbon Dioxide Absorption During Extraperitoneal and Transperitoneal Endoscopic Hernioplasty

Eberhard Sumpf, MD^*, Thomas Allen Crozier, MD, PhD^*, Dirk Ahrens, MD^*, Amselm Bräuer, MD^*, Thomas Neufang, MD, and Ulrich Braun, MD

Departments of *Anesthesiology, Emergency and Intensive Care Medicine, and Surgery, University of Göttingen Medical School, Göttingen, Germany

Address correspondence and reprint requests to Thomas A. Crozier, MD, PhD, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Address e-mail to tcrozie{at}gwdg.de

Transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) hernioplasty are probably associated with differing degrees of CO₂ absorption which can influence anesthetic management and perioperative morbidity. We studied 20 patients with either TAPP or TEP for perioperative CO₂ absorption (calculated from CO₂ elimination and metabolic CO₂ production) and ventilatory changes required to maintain normocapnia (blood gas analyses). CO₂ absorption reached plateau values in the TAPP group, but increased over time in the TEP group. Median CO₂ absorption during insufflation was 61 mL/min (range 43–78) for TAPP and 114 mL/min (range 75–178) for TEP, with a maximum of 114 mL/min (range 75–178) for TAPP and 258 mL/min (range 112–585) for TEP. Median minute ventilation (_E) required for maintaining normocapnia was 9.5 L/min (range 7.7–11.5) for TAPP and 12.9 L/min (range 9.0–22.6) for TEP (P < 0.01). Seven patients in the TEP group required over 18 L/min _E, although no patient in the TAPP group required more than 14 L/min _E. All patients in the TEP group had significant subcutaneous emphysema resulting in one case of delayed tracheal extubation. We conclude that CO₂ absorption is consistently less with TAPP.

Implications: The greater magnitude of carbon dioxide absorption during total extraperitoneal hernioplasty puts an additional load on the lungs and could pose a risk for patients with chronic lung disease who might be unable to eliminate excess carbon dixoide.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999