Comparison of Intraoperative Hemodynamic Parameters and Arterial-blood Gas Changes at Two Different Pneumoperitoneal Pressure Values
Condition: Pneumoperitoneum
MeSH terms: Pneumoperitoneum
Study type: Observational

Summary: 
      Clinic and metabolic consequences of pneumoperitoneum, achieved by insufflation of gas carbon
      dioxide, are still debated. Cardiovascular system suffering due to the compression of
      intra-abdominal venous structures can cause life-threatening complications. Increased partial
      pressure of carbon dioxide induces metabolic acidosis with further vascular suffering.
      Pneumoperitoneum reduces the pulmonary exchange volumes and bring renal suffering.

      Methods. The aim of this study is to evaluate the alterations in hemodynamic and
      hemogasanalysis parameters during the laparoscopic surgery at different pressure settings of
      pneumoperitoneum in order to assess the best pressure value.

      We evaluated and compared intraoperative hemodynamic and hemogasanalytic alterations in two
      groups of patients respectively subdue to laparoscopic cholecystectomy at a pneumoperitoneum
      pressure of 12 mmHg (group A) and at a pressure of 8 mmHg (group B).
    

Detailed description: 
      We evaluated intraoperative hemodynamic and hemogasanalytic alterations in two groups of
      randomized patients respectively operated at a pneumoperitoneum pressure of 12 mmHg (group A)
      and at a pressure of 8 mmHg (group B) to highlight any significant alterations.

      The clinical sample used in the study is composed by patients aged between 15 and 85 years
      affected by cholelithiasis and treated with laparoscopic cholecystectomy in the period
      between July 2019 and February 2020.

      20 patients, 9 men and 11 women, were enrolled. Group A included 10 patients, 5 men and 5
      women, with an average age of 47.9 years. Group B included 10 patients, 4 men and 6 women,
      with an average age of 50.7 years.

      The parameters evaluated were: heart rate (HR), average arterial blood pressure (BP),
      respiratory frequency (RF), oxygen saturation (SaO2), hemogasanalysis (PaO2, PaCO2, pH and
      HCO3-).

      The measurements were made at four stages: before the induction of anesthesia, after the
      anesthesia induction but before incision, 30 minutes after the pneumoperitoneum induction, 5
      minutes after the pneumoperitoneum releasing.

      The hemodynamic parameters (HR, RF, BP, SaO2) were extrapolated from the multiparameter
      monitor for each evaluation. The hemogasanalytic values (PaO2, PaCO2, pH and HCO3) were
      evaluated by the radial arterial sampling. The average and standard deviation were calculated
      for the quantitative data normally distributed. For the comparison of the quantitative data,
      the t-student test was used. A value of p ≤ 0,05 was considered statistically significant.
    

Intervention name(s): laparoscopic cholecystectomy
Intervention type(s): Procedure
Intervention description(s): removal of the gallbladder by laparoscopy at pneumoperitoneum pressure setting of 12 or 8 mmHg
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        patients aged between 15 and 85 years affected by symptomatic cholelithiasis and treated
        with laparoscopic cholecystectomy
      
Keywords: Blood gas analysis alterations; hemodynamic alterations