Comparison of Effects of PEEP Levels on Respiratory Mechanics in Patients Undergoing Laparoscopic Cholecystectomy

Study Overview
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Brief Summary
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Laparoscopic cholecystectomy is accepted as gold standard in the management of cholelithiasis. Although laparoscopic procedures have many advantages,intra-abdominal CO2 insufflation can cause decreased lung volumes and compliance, increased airway resistance and impaired ventilation-perfusion ratio. In this study, investigators aim to investigate effects of intra-operative PEEP treatment at 3 distinct levels on respiratory dynamics and elimination time of volatile anesthetic agent.

Detailed Description
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In the study, 75 ASA I-II patients aged 30-65 years will be randomized into 3 groups to receive 0 cmH2O PEEP (Group-1), 5 cmH2O PEEP (Group-2) and 8 cmH2O PEEP (Group-3) in PVC mode. In all patients underwent general anesthesia; hemodynamic parameters, Ppeak, Pplateau, compliance values as well as Fisevo/Fexpsevo ratio at 1 MAC and times from 1 MAC to 0.3 and 0.1 MAC will be recorded. In addition, preoperative and postoperative pulmonary function tests will be compared in all patients.

Official Title
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Comparison of Effects of 3 Different PEEP Levels on Hemodynamic, Respiratory Mechanics and Elimination of Volatile Anesthetic Agent in Patients Undergoing Laparoscopic Cholecystectomy

Conditions
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Respiratory System Abnormalities

Intervention / Treatment
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* Procedure: PEEP 0
* Procedure: PEEP 5
* Procedure: PEEP 8


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA (American Society of Anesthesiologists) I-II BMI of 25-30 patients scheduled to elective laparoscopic cholecystectomy. Exclusion Criteria: Patients with ASA III, IV, V risk, Patients with comorbid diseases that may increase intra-abdominal pressure or pulmonary hypertension, Patients with renal and hepatic failure, Patients with pregnancy and Patients using bronchodilator or steroid were excluded.

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Compliance<br>Pulmonary compliance (or lung compliance) is a measure of the lung's ability to stretch and expand. In clinical practice it is separated into two different measurements, static compliance and dynamic compliance. Static lung compliance is the change in volume for any given applied pressure. Dynamic lung compliance is the compliance of the lung at any given time during actual movement of air. Effects of intra-operative PEEP 0, PEEP 5, PEEP 8 treatment on static and dynamic compliance levels will be investigate. | Procedure: PEEP 0<br>* 0 cmH2O positive end expiratory pressure<br>Procedure: PEEP 5<br>* 5 cmH2O positive end expiratory pressure<br>Procedure: PEEP 8<br>* 8 cmH2O positive end expiratory pressure<br>|
| Pulmonary Function tests<br>Pulmonary function testing has diagnostic and therapeutic roles and helps clinicians answer some general questions about patients with lung disease. Effects of intra-operative PEEP 0, PEEP 5, PEEP 8 treatment on pulmonary function test values will be investigate. | Procedure: PEEP 0<br>* 0 cmH2O positive end expiratory pressure<br>Procedure: PEEP 5<br>* 5 cmH2O positive end expiratory pressure<br>Procedure: PEEP 8<br>* 8 cmH2O positive end expiratory pressure<br>|
| volatil agent elimination time<br>Volatile anaesthetics are eliminated in the terminal phase via the lungs. A low blood:gas partition coefficient is therefore necessary for quick removal of the anaesthetic. Effects of intra-operative PEEP 0, PEEP 5, PEEP 8 treatment on volatil agent elimination time will be investigate. | Procedure: PEEP 0<br>* 0 cmH2O positive end expiratory pressure<br>Procedure: PEEP 5<br>* 5 cmH2O positive end expiratory pressure<br>Procedure: PEEP 8<br>* 8 cmH2O positive end expiratory pressure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| levels of static-dynamic compliance with intra-operative PEEP treatment at 3 distinct levels |  | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| elimination time of volatile anesthetic agent with intra-operative PEEP treatment at 3 distinct levels |  | 1 month | 
| levels of p peak and p plateau pressures with intra-operative PEEP treatment at 3 distinct levels |  | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PEEP, compliance, peak airway pressures