None listed
Conditions
Brief summary
Satisfactory conditions for creating a pneumoperitoneum are facilitated by the administration of neuromuscular blocking drugs to accommodate CO2 into a relaxed abdomen without a corresponding increase in intra-abdominal pressure (IAP). However, as the tone of diaphragm is lost due to neuromuscular paralysis, rising IAP pushes the diaphragm into the thoracic cavity resulting in loss of lung volume in its bases. Basal atelectasis together with higher CO2 load can compromise with CO2 elimination and result in hypercapnia. The authors hypothesize, that satisfactory CO2 elimination can be maintained if the lung volume is maintained with the similar amount of positive end expiratory pressure (PEEP) that can counter the rise in IAP. The present study is designed to study the effect of PEEP similar to the IAP on gas exchange in patients undergoing laparoscopic cholecystectomy.
Interventions
Positive End Expiratory Pressures of 5 and 10 cm H20 were applied using the ventilator in the Datex Omheda Anaesthesia Machine.
75 patients were randomly allocated to Group 0PEEP (n=25, PEEP 0), Group 5PEEP (n=25, PEEP 5) and Group 10PEEP (n=25, PEEP 10) according to level of PEEP in whom pneumoperitoneum was created with Intra Abdominal Pressures of 14, 8 and 14 mm Hg respectively.
Before creation of pneumoperitoneum 0, 5 and 10 cm H2O of PEEP was applied in 0PEEP, 5PEEP and 10PEEP groups resp
Positive End Expiratory Pressures of 5 and 10 cm H20 were applied using the ventilator in the Datex Omheda Anaesthesia Machine. 75 patients were randomly allocated to Group 0PEEP (n=25, PEEP 0), Group 5PEEP (n=25, PEEP 5) and Group 10PEEP (n=25, PEEP 10) according to level of PEEP in whom pneumoperitoneum was created with Intra Abdominal Pressures of 14, 8 and 14 mm Hg respectively. Before creation of pneumoperitoneum 0, 5 and 10 cm H2O of PEEP was applied in 0PEEP, 5PEEP and 10PEEP groups respectively. The pneumoperitoneum was created by CO2 insufflation performed by the surgeon. IAP was set to be maintained at 14 mmHg by an automatic insufflator in 0PEEP and 10PEEP groups and 8 mm Hg in 5PEEP group. The PEEPs were applied upto 30 min of capnoperitonium.
Sponsors
Dr Yamini Subramani
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
15 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
All ASA I and II patients between the age group of 15-60 years scheduled to undergo elective laparoscopic cholecystectomy were recruited in the study after obtaining informed consent
Exclusion criteria
Patients with pre-existing pulmonary disease, cardiovascular disease, neuromuscular disease and pregnant patients were excluded from the study.
Outcome results
None listed