Uma Maheswari, P (2016) A prospective, randomized study to assess the effect of pneumoperitoneum on arterial and endtidal carbondioxide pressure gradient during laparoscopic surgery in adults. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: During laparoscopic surgery, Carbondioxide pneumoperitoneum is created resulting in hypercarbia which has complex effects on various systems of our body. PURPOSE: To assess the effects of pneumoperitoneum on arterial and end tidal carbondioxide pressure gradient during laparoscopic surgery in adults. METHODOLOGY: 60 patients of ASA 1 & 2 between the age of 20 to 60 years posted for elective laparoscopic appendicectomy or cholecystectomy were selected. They were anaesthesized, Intubated, paralysed and ventilated with constant ventilator settings (TV=10ml/kg, RR=12 to 14/mins). Intra abdominal pressure was maintained between 10-12 mmHg. Arterial blood sample were collected preinsufflation of CO2 and also intra operatively 15 minutes after CO2 pneumoperitoneum. We decided to study the changes in PaCO2, ETCO2, P(a-Et)CO2 gradient, and PH and bicarbonate. Also studied the hemodynamic changes due to pneumoperitoneum. RESULTS: There was significant increase in ETC02, PaCO2, P(a-Et)CO2 gradient, after CO2 insufflation but within clinically normal range. There was decrease in pH without change in bicarbonate concentration. And also slight increase in heart rate and diastolic blood pressure. CONCLUSION: There was increase in ETCO2 and PaCO2, P(a-Et)CO2 gradient significantly higher than pre insufflation value but with in physiological range. The arterial and endtidal carbondioxide pressure gradients are under the normal limits even after CO2 pneumoperitoneum in ASA 1 and 2 patients. The normal pressure P(a-Et)CO2 gradient implies adequate ventilation to alveoli and perfusion. ETCO2 correlate well with PaCO2. So it is best parameter to diagnose hyper carbia.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | pneumoperitoneum ; arterial and endtidal carbondioxide pressure gradient ; laparoscopic surgery ; adults ; prospective, randomized study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Punitha K |
| Date Deposited: | 15 Jun 2018 03:31 |
| Last Modified: | 15 Jun 2018 15:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8476 |
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