Arterial Blood Gas Analysis in Laparoscopic Cholecystectomy
Condition: Cholecystectomy, Laparoscopic
Study type: Interventional

Summary: 
      The investigator found out that as such the base line carbon dioxide (CO2) level is higher in
      smokers as compared to non-smokers even before creation of pneumoperitoneum, which is due to
      the compromised lung function following chronic smoking. This condition gets aggravated after
      creation of pneumoperitoneum which is very much evident from the serial arterial blood gas
      analysis. The level of CO2 remains elevated even after deflation of the pneumoperitoneum.
      Hence one has to be very much vigilant not only during intra-operative period but also in
      post-operative care unit. Hence serial ABG monitoring should be included as a part of the
      protocol especially in laparoscopic surgeries.
    

Detailed description: 
      Laparoscopic cholecystectomy procedure is the treatment of choice for cholelithiasis as it
      has several advantages like smaller and more cosmetic incision, reduced blood loss, less
      postoperative pain, reduced post-operative stay, low post-operative complications, and early
      mobilization. Although this type of surgery is minimally invasive in nature but creation of
      pneumoperitoneum and postural changes causes a number of physiological alterations. Carbon
      dioxide (CO2) is the most commonly used gas for this purpose because it does not support
      combustion, is cleared more rapidly than other gases, and is highly soluble in blood.
      However, the disadvantage of CO2 is that the absorption of CO2 can cause hypercapnia and
      respiratory acidosis. Hypercapnia activates the sympathetic nervous system leading to an
      increase in blood pressure, heart rate, arrhythmias and myocardial contractility as well as
      it also sensitizes myocardium to catecholamines. Increased IAP may compress venous vessels
      causing an initial increase in preload, followed by a sustained decrease in preload.

      Tobacco smoking is an internationally accepted health hazard. The United nation (UN) health
      agency reports that about 4.9 million people die each year across the globe due to cigarette
      smoking. Chronic smoking (more than 20 pack year at least for 10 year) causes a number of
      pathological changes in respiratory system which includes inflammatory changes in lung
      parenchyma, imbalance between protease and anti-protease, oxidative stress, cilliary
      dysfunction, mucosal hyper secretion, airflow limitation and pulmonary hypertension.

      Arterial blood gas analysis plays a very important role in assessing the acid-base status,
      adequacy of oxygenation and ventilation. It is very useful in management of critically ill
      patients and in patients with pulmonary disorders. It is also a standard part of work-up for
      the patients who present with unexplained hypoxemia and dyspnea. An ABG test uses blood drawn
      from an artery, where the oxygen and carbon dioxide levels can be measured before they enter
      body tissues.
    

Intervention name(s): ABG analysis
Intervention type(s): Other
Intervention description(s): ABG analysis was performed and compared between two groups
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Arterial blood gas sample was drawn from both the groups and analysed for any change in the desired parameters
Masking: Double (Participant, Investigator)
Primary purpose: Screening