Abstract
Twelve ASA physical status I-II patients undergoing pelvic laparoscopy for infertility were enrolled in a study to quantify the effects of CO2 insufflation and the Trendelenburg position on CO2 elimination and pulmonary gas exchange, and to determine the minute ventilation required to maintain normocapnia during CO2 insufflation. Measurements of O2 uptake (VO2), CO2 elimination (VCO2), minute ventilation (Ve), FlO2, and respiratory exchange ratio (RQ) were made during three steady states: control (C) taken after 15 min of normoventilation but before CO2 insufflation, after 15 min (L1) and 30 min (L2) of hyperventilation during CO2 insufflation. The FlO2 was controlled at 0.5 and arterial blood gases were used to calculate the oxygen tensionbased indices of pulmonary gas exchange. After 15 min and 30 min of CO2 insufflation, the volume of CO2 absorbed from the peritoneal cavity was estimated at 42.1 ± 5.1 and 38.6 ± 6.6 (SEM) ml · min−1 respectively, increasing CO2 elimination through the lungs by about 30%. Hyperventilation of the lungs by a 20–30% increase in minute ventilation maintained normocapnia. Despite the CO2 pneumoperitoneum and Trendelenburg position, there was no impairment of pulmonary oxygen exchange as estimated by (A−a)DO2. This study demonstrated that a 30% increase in minute ventilation, achieved by increasing tidal volume to more than 10 ml · kg−1, is sufficient to eliminate the increased CO2 load and maintain normal pulmonary O2 exchange during pelvic laparoscopy.
Résumé
Douze patientes de la classe ASA I ou II subissant une laparoscopie pelvienne pour infertilité ont été incluses dans une étude qui visait d’une part, à quantifier let effets conjoints de l’insufflation du CO2 et de la position de Trendelenbourg sur l’élimination du CO2 ainsi que sur les échanges gazeux pulmonaires, et d’autre part, de déterminer la ventilation requise pour maintenir une normocapnie pendant l’insufflation. Trois moments d’equilibre ont été déterminés pour faire des mesures de captation d’O2 (VO2), d’élimination de CO2 (VCO2), de ventilation minute (VE), de FlO2 et de quotient respiratoire (RQ). Ces moments sont: 15 minutes aprés une ventilation normale et précédant l’insufflation de CO2 (C); 15 minutes (L1) et 30 minutes (L2) d’hyperventilation accompagnant l’insufflation du CO2. La FlO2 maintenue à 0.5 et la mesure des gaz artériels ont permis de calculer les échanges pulmonaires dépendant des pressions partielles en O2. Quinze et 30 minutes après l’insufflation du CO2, la quantite de CO2 absorbee par la cavité péritonéale a été évaluée successivement à 42.1 ± 5.1 ml · min−1 et à 38.6 ± 6,6 (SEM) ml · min−1, entraînant une augmentation d’élimination pulmonaire de 30%. Une augmentation de ventilation minute de 20 a 30% à permis de maintenir une normocapnie. Malgre la présence de CO2 dans le péritoine et la position de Trendelenbourg, il n’y a pas eu d’altération des echanges pulmonaires en O2 estimes par la DO2 (A−a). Cette étude prouve qu’une augmentation de ventilation-minute de 30%, obtenue par l’augmentation du volume courant à plus de 10 ml · kg−1 suffit pour éliminer le surplus de CO2 et maintenir des échanges respiratoires normaux en O2 pendant une laparoscopie pelvienne.
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Tan, P.L., Lee, T.L. & Tweed, W.A. Carbon dioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth 39, 677–681 (1992). https://doi.org/10.1007/BF03008229
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DOI: https://doi.org/10.1007/BF03008229