DOES HYPERCARBIA DEVELOP FASTER DURING LAPAROSCOPIC HERNIORRHAPHY THAN DURING LAPAROSCOPIC CHOLECYSTECTOMY - ASSESSMENT WITH CONTINUOUS BLOOD-GAS MONITORING

The use of CO2 to create and maintain a pneumoperitoneum during laparo scopic surgery may lead to hypercarbia and acidosis. CO2 is also insuf flated into the preperitoneal space to create and maintain a pneumopre peritoneum for laparoscopic herniorrhaphy. This study examined the inf luence of CO2 pneumopreperitoneum on the development of hypercarbia an d acidosis assessed with continuous intraarterial blood gas monitoring . Changes in blood gas values were measured with both continuous intra arterial and intermittent blood gas monitoring. Over a 4-mo period, bl ood gas values of 14 patients undergoing laparoscopic herniorrhaphy (p neumopreperitoneum) were compared with those of 13 patients undergoing laparoscopic cholecystectomy (pneumoperitoneum) in a tertiary referra l center. Additionally, heart rate and blood pressure were measured du ring stable ventilation at constant insufflation pressure. Pneumoprepe ritoneum resulted in a significantly faster development of hypercarbia (P = 0.023) and acidosis (P = 0.027) than pneumoperitoneum. These res ults were not explained when corrected for changes in hemodynamic and ventilatory variables using analysis of covariance. We conclude that t he more rapid development of hypercarbia and acidosis during pneumopre peritoneum can be explained by increased CO2 absorption through an inc reasing gas exchange area during the procedure and through a larger wo und bed.