M. Vegfors et al., CHANGES IN END-TIDAL CARBON-DIOXIDE DURING GYNECOLOGIC LAPAROSCOPY - SPONTANEOUS VERSUS CONTROLLED VENTILATION, Journal of clinical anesthesia, 6(3), 1994, pp. 199-203
Study Objective: To study the changes in PETCO2 during spontaneous and
controlled ventilation in patients undergoing gynecologic laparoscopy
. Design: Randomized, unblinded study. Setting: Department of Gynecolo
gy, University Hospital, Linkoping; Sweden; Central Hospital, Norrkopi
ng, Sweden. Patients: Forty healthy patients undergoing gynecologic la
paroscopy. Interventions: Patients were divided into 4 groups: Group 1
breathed spontaneously via an endotracheal tube, while the other thre
e groups underwent controlled ventilation to an initial PETCO2 of 3 kP
a (22 mmHg) (Group 2), 4 KPa (30 mmHg) (Group 3), or 5 kPa (37 mmHg) (
Croup 4). Measurements and Main Results: PETCO2 levels were measured a
t fixed time intervals. Arterial blood gas analyses were done to compa
re the difference between PETCO2 and PaCO. In Group 1, PETCO2 increase
d soon after insufflation and remained above G kPa (44 mmHg) throughou
t the procedure. In Groups 2, 3, and 4, PETCO2 also rose after insuffl
ation, and an initial PETCO2 of 4 KPa (30 mmHg) was ideal, as all PETC
O2 values were less than 5.5 kPa (41 mmHg). Occasional episodes of arr
hythmia were seen in Group 1. However no major adverse effects were ob
served in any of the groups. Conclusions: In view of the high PETCO2 l
evels, spontaneous breathing should be avoided during gynecologic lapa
roscopy, and ventilation to an initial PETCO2 of 4 kPa (30 mmHg) is re
commended during controlled ventilation.