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REGIONAL ANESTHESIA

The Difference Between Intramural and Arterial Partial Pressure of Carbon Dioxide Increases Significantly During Laparoscopic Cholecystectomy: The Effect of Thoracic Epidural Anesthesia

Koichiroh Nandate, MD^*, Masanori Ogata, MD^*, Masahiro Nishimura, MD^*, Takefumi Katsuki, MD, Shinichi Kusuda, MD, Kohji Okamoto, MD, Naoki Nagata, MD, and Akio Shigematsu, MD^*

Departments of *Anesthesiology and First Surgery, University of Occupational and Environmental Health, Japan

Address correspondence and reprint requests to Masanori Ogata, MD, Department of Anesthesiology, University of Occupational and Environmental Health, 1–1 Iseigaoka, Yahatanishiku, Kitakyushu 807–8555, Japan. Address email to mogata{at}med.uoeh-u.ac.jp

We studied the effects of pneumoperitoneum on gastric submucosal perfusion metabolism during elective laparoscopic cholecystectomy (LASC) by measuring the PCO₂ gap, defined as the difference between intramucosal PCO₂ and arterial PCO₂, using gas tonometry in 20 patients. Furthermore, we examined whether thoracic epidural anesthesia (TEA) affects gastric submucosal perfusion metabolism during LASC. Patients were randomly allocated to receive general anesthesia (group G, n = 10) or general anesthesia combined with TEA (group E, n = 10). In both groups, the PCO₂ gap increased significantly during pneumoperitoneum and remained at this level until the end of surgery compared with the baseline value. There were no significant differences in PCO₂ gap values between the two groups at any time sampled. These results suggested that pneumoperitoneum significantly impaired gastric submucosal perfusion and metabolism and that TEA did not attenuate the impairment of gastric submucosal perfusion during or after pneumoperitoneum.

IMPLICATIONS: We investigated the effect of pneumoperitoneum on gastric submucosal perfusion by measuring PCO₂ gap with the use of gas tonometry. PCO₂ gap significantly increased during and after the pneumoperitoneum compared with the control level. Thoracic epidural anesthesia did not attenuate this inhibition.