Gülşah KARAÖREN, Emre ÇELİKSOY, Nurten BAKAN, Ömer Torun ŞAHİN, Hüsnü Mert ARINALP

Comparison of the effects of PEEP levels on respiratory mechanics and elimination of volatile anesthetic agents in patients undergoing laparoscopic cholecystectomy; a prospective, randomized, clinical trial

Background/aim: In laparoscopic procedures, intraabdominal carbon dioxide (CO2) insufflation can cause decreased compliance, increased airway resistance, and impaired ventilation-perfusion ratios. We aimed to investigate the effects of intraoperative positive end-expiratory pressure (PEEP) treatment on respiratory dynamics and elimination time of volatile anesthetic agents. Materials and methods: In the present study, 75 ASA I-II patients were randomized into 3 groups to receive 0 cmH2O PEEP (group I), 5 cmH2O PEEP (group II), or 8 cmH2O PEEP (group III). Hemodynamic parameters, peak and plateau inspiratory airway pressures (Ppeak, Pplateau), compliance values, the ratio of the fractions of inspired and expired concentration of sevoflurane (Fi/Fexp sevoflurane) at 1 MAC, times from 1 to 0.3 and 0.1 MAC and values for pulmonary function tests (PFT) were recorded. Results: Ppeak and Pplateau in group III were higher; compliance values in group I and the extent of reduction in postoperative forced vital capacity (FVC) in group III were lower than those in the other groups (P < 0.05). No significant difference was observed between the groups regarding times from 1 to 0.3 MAC and times from 0.3 to 0.1 MAC. Conclusion: It was found that 8 cmH2O PEEP increased compliance without clinically significant pulmonary deterioration and that 8 cmH2O PEEP led to less impairment in postoperative PFTs compared to 0 and 5 cmH2O PEEP but had no effect on sevoflurane elimination time.

PDF

___

1. Karsten J, Heinze H, Meier T. Impact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualized by electrical impedance tomography. Minerva Anestesiol 2014; 80: 158-166.
2. Aydın V, Kabukcu HK, Sahin N, Mesci A, Arici AG, Kahveci G, Ozmete O. Comparison of pressure and volume-controlled ventilation in laparoscopic cholecystectomy operations. Clin Respir J 2016; 3: 342-349.
3. Himal HS. Minimally invasive (laparoscopic) surgery. Surg Endosc 2002; 8: 265-270.
4. Suter M, Meyer A. A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endsc 2001; 15: 1187-1192.
5. Dikmen Y, Eminoğlu E, Salihoğlu Z, Demiroluk S. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 2003; 58: 745-748.
6. Warner DO. Preventing postoperative pulmonary complications. The role of the anesthesiologist. Anesthesiology 2000; 92: 1467-1472.
7. Salihoglu Z, Demiroluk S, Cakmakkaya S, Gorgun E, Kose Y. Influence of the patient positioning on respiratory mechanics during pneumoperitoneum. Middle East Journal of Anaesthesiology 2002; 16: 521-528.
8. Marini JJ, Hotchkiss JR Jr. PEEP in the prone position: reversing the perfusion imbalance. Crit Care Med 1999; 27: 1-2.
9. Morgan GE, Mikhail MS, Murray MJ, Kleinman W, Nitti GJ, Nitti JT, Raya J. Clinical Pharmacology: Inhalational Anesthetics. In: Morgan GE, Mikhail MS, Murray MJ, editors. Clinical Anesthesiology. New York, NY, USA: McGraw-Hill; 2006. pp. 155-178.
10. Yamazaki Y, Mimura M, Sonoda H, Seki S, Namiki A. Positive end-expiratory pressure facilitates washout of nitrous oxide in patients with obstructive pulmonary disease. The Japanese Journal of Anesthesiology 1998; 47: 404.
11. Oikkonen M, Tallgren M. Changes in respiratory compliance at laparoscopy: measurements using side stream spirometry. Can J Anaesth 1995; 42: 495-497.
12. Whalen FX, Gajic O, Thompson GB. The effects of the alveolar recruitment maneuver and positive end expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anaesth Analg 2006; 102: 298-305.
13. Kim JY, Shin CS, Kim HS, Jung WS, Kwak HJ. Positive endexpiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy. Surg Endosc 2010; 24: 1099-1103.
14. Kundra P, Subramani Y, Ravishankar M, Sistla SC, Nagappa M, Sivashanmugam T. Cardiorespiratory effects of balancing PEEP with intra-abdominal pressures during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2014; 24: 232-239.
15. Russo A, Di Stasio E, Scagliusi A, Bevilacqua F, Isgrò MA, Marana R, Marana E. Positive end-expiratory pressure during laparoscopy: cardiac and respiratory effects. J Clin Anesth 2013; 25: 314-320.
16. Sen M, Ozol D, Bozer M. Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy. Dig Dis Sci 2009; 54: 2742-2747.
17. Adanir T, Atay A, Sencan A, Aksun M, Karahan N. Effect of cigarette smoking on the washout time of sevoflurane anesthesia. BMC Anesthesiology 2010; 10: 8.