Effect of carbon dioxide pneumoperitoneum on acid base balance during laparoscopic surgeries
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 9, Issue 1
Abstract
Background: Carbon dioxide is the most commonly used gas to induce pneumoperitoneum during laparoscopic surgeries, as CO2 levels in blood and expiratory gas can be easily measured and monitored. However, insufflations of carbon dioxide into the peritoneum may lead to alteration in the acid-base balance. Aim: To study the effect of carbon dioxide pneumoperitoneum on acid-base balance during laparoscopic surgeries. Material and Methods: The study included 40 adult patients of either sex, scheduled to undergo elective laparoscopic surgical procedures. Measurement and comparison was done between preinsufflation and predesufflation values of arterial blood gas analysis. Results: Comparison of arterial blood gas analysis of preinsufflation and predesufflation sample indicated that pneumoperitoneum originated a definite and significant fall in mean arterial pH from 7.41±0.03 to 7.37±0.04 (p< 0.001), significant decrease in mean base excess from -1.36±1.53 mmol/lit to -2.32±2.08 mmol/lit (p< 0.001) and elevation in mean PaCO2 from 36.73±3.96 mmHg to 40.52±4.19 mmHg (p< 0.001); with no significant change in bicarbonate concentration (p> 0.05). These changes were seen inspite of ventilatory adjustment to maintain etCO2 within acceptable range. We found no actual acid base abnormality but definite acidotic trend with statistical significance and this trend was of mixed type i.e. respiratory with metabolic component. Conclusion: Pneumoperitoneum during laparoscopic surgery is associated with alteration in acid base balance and significant decrease in arterial pH during pneumoperitoneum with development of mild mixed respiratory and metabolic acidosis in healthy adults. These acid base changes during laparoscopy may even be more exaggerated in patients with cardiovascular and pulmonary diseases with significant anaesthetic implications.
Authors and Affiliations
Upendra M Kanzarkar, Anjali Savargaonkar
Keywords
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- EP ID EP440209
- DOI 10.26611/1015912
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