Respiratory mechanics during laparoscopic cholecystectomy: the effects of the abdominal wall lift. 1998

P Y Carry, and D Gallet, and Y François, and J P Perdrix, and A Sayag, and F Gilly, and A Eberhard, and V Banssillon, and P Baconnier
Department of Anaesthesiology and Intensive Care Medicine, Centre Hospitalier Universitaire Lyon-Sud, Lyon-Pierre Benite, France. carry@univ-lyon1.fr

The abdominal wall lift (AWL) has been proposed for laparoscopic cholecystectomy to reduce hemodynamic effects caused by carbon dioxide (CO2) and high intraabdominal pressures (IAP). Data concerning effects of AWL on respiratory mechanics are scant. We therefore used a noninvasive method to evaluate whether the AWL could offset these effects. The PETCO2, airflow, and airway pressure were continuously measured in nine patients undergoing laparoscopic cholecystectomy using an AWL with minimal CO2 insufflation. We used a least-squares method to calculate maximal airway pressure (Pmax), elastance (Ers), and resistances (Rrs) of the respiratory system. After CO2 insufflation, the initiation of AWL resulted in a significantly decreased IAP (from 13 to 6 mm Hg; P < 0.001) and Rrs (from 20.6 to 17.8 cm H2O.L(-1).s(-1); P = 0.029), whereas Ers was partly modified (34.0 to 33.3 cm H2O/L; not significantly different). With AWL, we hypothesized that the diaphragm remained flat and stiff, outweighing the beneficial effect of the decrease of IAP on Ers. PETCO2 significantly increased after AWL and at the end of the procedure. We conclude that AWL partly reverses the impairment of the respiratory mechanics induced by CO2 insufflation during laparoscopic surgery. CONCLUSIONS The abdominal wall lift (AWL), acting on the abdominal chest wall, had some benefits during laparoscopic surgery by limiting CO2 peritoneal insufflation and several side effects, such as hemodynamics. We examined the consequences of this technique on respiratory mechanics in nine patients undergoing laparoscopic cholecystectomy. Our findings suggest that the AWL decreases intraabdominal pressure and respiratory resistances without a significant effect on respiratory elastance.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011028 Pneumoperitoneum, Artificial Deliberate introduction of air into the peritoneal cavity. Artificial Pneumoperitoneum
D011312 Pressure A type of stress exerted uniformly in all directions. Its measure is the force exerted per unit area. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Pressures
D002245 Carbon Dioxide A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. Carbonic Anhydride,Anhydride, Carbonic,Dioxide, Carbon
D004548 Elasticity Resistance and recovery from distortion of shape.
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000005 Abdomen That portion of the body that lies between the THORAX and the PELVIS. Abdomens
D000009 Abdominal Muscles Muscles forming the ABDOMINAL WALL including RECTUS ABDOMINIS; ABDOMINAL OBLIQUE MUSCLES, transversus abdominis, pyramidalis muscles and quadratus abdominis. Cremaster Muscle,Pyramidalis Muscle,Quadratus Abdominis,Transverse Abdominal,Transversus Abdominis,Abdominal Muscle,Abdominal, Transverse,Abdominals, Transverse,Abdomini, Quadratus,Abdominis, Quadratus,Cremaster Muscles,Muscle, Abdominal,Muscle, Cremaster,Muscle, Pyramidalis,Muscles, Abdominal,Muscles, Cremaster,Muscles, Pyramidalis,Pyramidalis Muscles,Quadratus Abdomini,Transverse Abdominals

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