Objective:

This study has targeted to compare the effects of CO2 pneumoperitoneum, generated by 12 and 14 mmHg pressure that leads to increase in intra-abdominal pressure, on ventilation dynamics, hemodynamics and metabolism in the laparoscopic cholecsytectomies.

Material and Methods:

Our study was carried out prospectively using the method of randomisation, after Okmeydanı Training and Research Hospital Ethics Committee approval. Totally 50 adult patients who were ASA (American Society of Anesthesiology) I-II and scheduled for elective laparoscopic cholecsytectomy, were enrolled in the study, after voluntary informed consents were obtained. Patients were divided into two groups according to CO2 pneumoperitoneum pressure generated during laparoscopic cholecsytectomy. Group I; 12 mmHg, Group II;14 mmHg.

Results:

Mean age of the patients enrolled in the study was 53.08±11.08, with 36 (72 %) being women and 14 (28 %) men. There were not any statistically significant difference between the two groups (p>0.05) concerning Ppeak (peak pressure), heart rate, arterial blood pressure, central venous pressure and cardiac output, arterial blood gas lactate and central venous blood gas lactate values, measured after induction, 10th minute, 20th minute and 30th minute of pneumoperitoneum and when the abdomen was closed. For the AST, ALT, GGT, ALP, LDH, total bilirubin, direct bilirubin, urea and creatinin levels preoperatively and postoperatively, statistically significant differences were not detected between the two groups (p>0.05). Bladder pressures on 10th, 20th, and 30th minute of pneumoperitoneum, were significantly statistically higher (p<0.05) in Group II in compairson to Group I but, at the abdomen closing period there was no significant difference between two groups (p>0.05).

Conclusion:

Pneumoperitoneum created in the 12 and 14 mmHg pressure during laparoscopic cholecsytectomy, does not affect respiratory mechanics, hemodynamics and metabolism;and possible complications can be prevented by balanced general anesthesia, controlled ventilation, careful positioning and peroperative monitoring and especially careful observation during the CO2 insufflation.

Keywords: intra-abdominal hypertension, abdominal compartment syndrome, laparoscopic surgery, cholecsytectomy