ALTERATIONS IN RESPIRATORY-FUNCTION AND HEMODYNAMICS DURING LAPAROSCOPIC CHOLECYSTECTOMY UNDER PNEUMOPERITONEUM

Respiratory function and hemodynamics were studied during laparoscopic cholecystectomy (LC) under a 10 mmHg pneumoperitoneum (PP) by carbon dioxide insufflation. Blood-gas analysis and measurement of cardiac fu nction by using a Swan-Ganz catheter were performed. Creatinine cleara nce rate was measured preoperatively and intraoperatively. Compared wi th values obtained before the institution of PP, blood-gas analysis sh owed a significant increase in PCO2 (P < 0.01), and a significant decr ease in pH (P < 0.01) and base excess (P < 0.05) during PP. With respe ct to cardiac function, there was no significant change in cardiac out put, pulmonary arterial pressure, and pulmonary arterial wedge pressur e. Intraoperative creatinine clearance rate (Ccr) was decreased in 29 of 48 cases, increased in 18 cases, and unchanged in 1 case, resulting in no significant difference overall between the values measured preo peratively and intraoperatively. However, in eight individual cases, t he Ccr was found to have decreased significantly. Although alterations in respiratory function were observed, LC at 10 mmHg PP did not cause any crucial problems in respiratory or cardiac function. It should be kept in mind, however, that renal blood flow may decrease in some cas es even at intraabdominal pressures under 10 mmHg.