[The hemodynamic and ventilatory effects between Trendelenburg and reverse Trendelenburg position during laparoscopy with CO2-insufflation].

Abstract

Thirty ASA class I female patients underwent gynecologic pelvioscopy and laparoscopic cholecystectomy were included in this study. All of them received general anesthesia and certain volume of CO2 pneumoperitoneum. We evaluated the effect of positioning (Trendelenburg as group I and reverse Trendelenburg as group II) on hemodynamic parameters and ventilation. The hemodynamic parameters, ventilation, and arterial blood gas were determined at the following stages: (1) after 10 minutes of normoventilation and before CO2 pneumoperitoneum (as control), (2) 5 minutes after CO2 pneumoperitoneum and positioning, (3) 25 minutes after positioning, (4) 50 minutes after positioning, (5) 10 minutes after resumption of supine position and decompression of abdomen. Arterial blood pressure, heart rate, minute volume, end-tidal CO2, oxygen saturation and blood gas analysis were taken during normoventilation. We found that there was no statistical difference between either group in respect to hemodynamic parameters. For the ventilation, both groups had appropriate SpO2 during the period of CO2 pneumoperitoneum, but PaCO2 was significantly increased in group I 25 min after CO2 pneumoperitoneum and Trendelenburg positioning. Nonetheless, end-tidal CO2 was not significantly increased. pH value and PaCO2 did respectively decrease and increase significantly in group I 50 min after Trendelenburg position. However, no change was found in end-tidal CO2. All data were not significantly different after resumption of supine position and decompression of abdomen. Conclusively, except that pH and PaCO2 had changed after a period of Trendelenburg positioning with CO2 pneumoperitoneum, the patients who underwent laparoscopic surgery with normoventilation have no hemodynamic and respiratory change.(ABSTRACT TRUNCATED AT 250 WORDS)