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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Postoperative Kohlendioxidresorption – Laparoskopische Cholezystektomie – Kapnoperitoneum ; Key words: Postoperative carbon dioxide resorption – Laparoscopic cholecystectomy – Capnoperitoneum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption. Studies exist on the course of end-expiratory CO2 (PeCO2) alone over a longer postoperative period of time in extubated patients during spontaneous breathing. The goal of this prospective study was to investigate the amount of CO2 resorbed from the abdominal cavity in the postoperative period by means of CO2 metabolism. Methods. After giving informed consent to the study, which was approved by the local ethics committee, 20 patients underwent laparoscopic cholecystectomy. All patients received general endotracheal anaesthesia. After induction, total IV anaesthesia was maintained using fentanyl, propofol, and atracurium. Patients were ventilated with oxygen in air (FiO2 0.4). The intraabdominal pressure during the surgical procedure ranged from 12 to 14 mm Hg. Thirty minutes after releasing the capnoperitoneum (KP), CO2 elimination (V˙CO2), oxygen uptake (V˙O2), and respiratory quotient (RQ) were measured every minute for 1 h by indirect calorimetry using the metabolic monitor Deltatrac according to the principle of Canopy. Assuming an unchanged metabolism, the CO2 resorption (ΔV˙CO2) at any given time (t) can be calculated from ΔV˙CO2 (t)=V˙CO2 (t)−RQ (preop) V˙O2 (t). It was thus necessary to define the patient's metabolism on the day of operation. The first data were collected before surgery and after introduction of the arterial and venous cannulae for a 15-min period. Measuring point 0 was determined after exsufflation of the KP and emptying of the remaining CO2 via manual compression by the surgeon at the end of surgery. Patient's tracheas were extubated and metabolic monitoring started 30 min after release of the KP for 60 min. Simultaneously, a nasal side-stream capnometry probe was placed and the PeCO2 and respiratory frequency (RF) were obtained by the Capnomac Ultima (Datex) and registered every minute as well. Values were averaged over four periods of 15 min each. An arterial blood gas sample was drawn at the end of every 15-min period. Postoperative pain was scored by a visual analog scale and completed by a subjective index questionnaire on general well-being. All data were analysed by the Friedman or Wilcoxon test;P〈0.05 was considered significant. Results. The findings do not indicate CO2 resorption in the postoperative period after laparoscopic cholecystectomy (Tables 2 and 3, Fig. 1). Arterial CO2 as well as PeCO2 were elevated postoperatively (45 mm Hg vs. 36 mm Hg intraoperatively), while V˙CO2 and V˙O2 were unchanged when compared to the preoperative measuring period. The postoperative RF was comparable to preoperative values. Calculated ΔCO2 was lower than 10 ml/min and within accuracy of measurements. The postoperative pain index ranged between 3 and 4, and 3.75 – 15 mg piritramid was administered. All patients feld tired immediately after the operation, but scores improved slightly at the end of the 60-min period of metabolic monitoring. Conclusions. There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP. Up to this time, any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled. An increased PeCO2 as late as 30 to 90 min postoperatively should rather be considered a consequence of residual anaesthetics and narcotics than of CO2 resorption.
    Notes: Zusammenfassung. Das am Ende einer laparoskopischen Operation nicht vollständig aus der Abdominalhöhle abgelassene CO2 muß resorbiert und abgeatmet werden. Ziel dieser Untersuchung war es, postoperativ mit den Parametern des Kohlendioxidhaushaltes die CO2-Resorption zu beurteilen. Bei 20 Patienten nach laparoskopischer Cholezystektomie wurden ab der 30. Minute nach Exsufflation des Kapnoperitoneums (KP) für 1 h nach dem Canopyprinzip am spontan atmenden und extubierten Patienten die CO2-Abgabe (V˙CO2), die Sauerstoffaufnahme (V˙O2) und der respiratorische Quotient (RQ) minütlich ermittelt. Der endtidale CO2-Partialdruck (PeCO2) und die Atemfrequenz (RF) wurden kontinuierlich aufgezeichnet. Am Ende jeder 15 min wurde der arterielle CO2-Partialdruck (PaCO2) bestimmt. Die CO2-Resorption (ΔV˙CO2) zum Zeitpunkt t kann mit dem präoperativ bestimmten RQ berechnet werden: ΔV˙CO2 (t)=V˙CO2 (t)−RQ (präop) V˙O2 (t). Der arterielle und der endtidale CO2-Partialdruck sind postoperativ um ca. 9 mm Hg erhöht, aber die ΔV˙CO2 ist über den gesamten postoperativen Meßzeitraum unter 10 ml/min. Unter der Voraussetzung der bestmöglichen Entleerung des KP durch den Chirurgen werden CO2-Reste aus der Peritonealhöhle nach Ablassen des KP innerhalb der ersten 30 min resorbiert und abgeatmet. Ein 30 bis 90 min postoperativ noch erhöhter PeCO2 weist eher auf einen verminderten Atemantrieb als auf eine CO2-Resorption hin.
    Type of Medium: Electronic Resource
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