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Prolonged inspiratory time produces better gas exchange in patients undergoing laparoscopic surgery: A randomised trial.

Authors :
Kim WH
Hahm TS
Kim JA
Sim WS
Choi DH
Lee EK
Lee SM
Source :
Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2013 May; Vol. 57 (5), pp. 613-22. Date of Electronic Publication: 2013 Mar 15.
Publication Year :
2013

Abstract

Background: Laparoscopic surgery performed with a patient in the Trendelenburg position is known to have adverse effects on pulmonary gas exchange and respiratory mechanics. We supposed that prolonged inspiratory time can improve gas exchange at lower airway pressure.<br />Methods: One hundred patients undergoing gynaecologic laparoscopic surgery were randomly assigned to one of four groups: conventional inspiratory-to-expiratory (I : E) ratio (Group 1 : 2), I : E ratio of 1 : 1 (Group 1 : 1), 2 : 1 (Group 2 : 1), or 1 : 2 with external positive end-expiratory pressure (PEEP) of 5 cmH2 O (Group 1 : 2 PEEP). Tidal volume was set to 6 ml/kg, and I : E ratio was adjusted at the onset of pneumoperitoneum. Arterial blood gas analysis with measurements of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2 /FiO2 ), and physiologic dead space-to-tidal volume ratio (VD /VT ) was performed 15 min after anaesthetic induction (T1), and 30 (T2) and 60 min (T3) after onset of CO2 insufflation.<br />Results: PaO2 /FiO2 at T3 in Groups 1 : 1, 2 : 1, and 1 : 2 PEEP were higher than Group 1 : 2. The partial pressure of arterial carbon dioxide at T3 in Group 2 : 1 was lower than the other groups. The VD /VT at T2 and T3 were lower in Groups 1 : 1 and 2 : 1 than Groups 1 : 2 and 1 : 2 PEEP. Peak or plateau airway pressure was higher in Group 1 : 2 PEEP than the other groups.<br />Conclusions: A prolonged inspiratory time demonstrated a beneficial effect on oxygenation. Furthermore, it showed better CO2 elimination without elevating the peak or plateau airway pressure compared with applying external PEEP. In terms of gas exchange and respiratory mechanics, a prolonged inspiratory time appears to be superior to applying external PEEP in patients undergoing laparoscopic surgery in the Trendelenburg position.<br /> (© 2013 The Acta Anaesthesiologica Scandinavica Foundation.)

Details

Language :
English
ISSN :
1399-6576
Volume :
57
Issue :
5
Database :
MEDLINE
Journal :
Acta anaesthesiologica Scandinavica
Publication Type :
Academic Journal
Accession number :
23496092
Full Text :
https://doi.org/10.1111/aas.12104