Acid Base Balance Alterations during Transperitoneal and Retroperitoneal Laparoscopic Urologic Surgeries.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2017, Vol 2, Issue 6
Abstract
Background: The laparoscopic approach requires CO2 gas insufflation with positive pressure resulting in increased intra abdominal pressure (IAP) and systemic CO2 absorption. This may lead to acid base alterations of respiratory, metabolic or mixed in nature. While degree of CO2 absorption and its cardiorespiratory changes have been compared for the transperitoneal and retroperitoneal laparoscopic approaches by few studies, none of the study have compared metabolic changes in urologic laparoscopic surgeries to our knowledge. Aims and Objectives: We conducted a study to compare the change in acid base balance in patients undergoing elective laparoscopic urologic surgeries either through transperitoneal or retroperitoneal approach. Settings and design: single centre prospective nonrandomized human study Methods: Patients were divided into two groups according to the laparoscopic approach used; Transperitoneal (Trans) and Retroperitoneal (Retro). All patients were given general anesthesia and were mechanically ventilated. Minute ventilation was adjusted to maintain EtCO2 level 35 +/- 5 mmHg. Arterial blood samples were taken twice; first, before gas insufflation, and second,at the end of surgery after desufflation for the analysis of PaCO2, pH, bicarbonate, base excess, lactate and anion gap. Data collected and compared statistically. Results: Duration of pneumoperitoneum was longer in Trans group than Retro group (196.6 +/- 65.63 min vs 148 +/- 69.43 min, p - 0.022). pH shifts from normal to acidic at the end of pneumoperitoneum in both the groups. Decrease in the bicarbonate in Trans group was statistically significant as compared to Retro group (20.66 +/- 2.23 vs 21.94 +/- 1.78 mEq/L, p - 0.013). Out of 60% patients who developed acid base disturbance in Trans group, 36%, 20% and 4% had mixed, metabolic and respiratory acidosis, respectively. While in Retro group, 40 percent had acid base balance disturbance with metabolic, respiratory and mixed acidosis developed in 16%, 16% and 8% of the patients, respectively. Conclusion: Acid base balance shifts toward acidosis at the end of pneumoperitoneum in both the approaches during laparoscopic urologic surgeries. Acidosis in retroperitoneal approach was attributable to respiratory component more while in transperitoneal approach it was more related to metabolic component.
Authors and Affiliations
Nama Rajnish
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