A comparative clinical study to assess preinsufflation versus postdesufflation changes in arterial blood gas and pH in patients undergoing laparoscopic cholecystectomies under general anaesthesia

Abstract

Introduction: Pneumoperitoneum for laparoscopic surgeries leads to multiple changes in the mechanics of respiration and heart function. Arterial blood gas analysis can be used for the patients oxygenation, ventilation ,gas exchange and acid base homeostasis as well as to provide immediate information about electrolytes. Aims: To assess preinsufflation versus postdesufflation changes in arterial blood gas, pH, end tidal CO2 and hemodynamic parameters in patients undergoing laparoscopic cholecystectomies under general anaesthesia. Material and methods: 25-45 yrs of 80 patients, ASA grade I and II were randomly divided into two groups. Group1 –arterial blood sample was collected after 30 min of desufflation. Group 2- arterial blood sample was collected after 60 min of desufflation. Intraoperative monitoring of pulse rate, blood pressure (SBP, DBP, MBP), SpO2, and EtCO2 was done before and after induction, pre-insufflation, after creation of pneumoperitoneum and thereafter at interval of 5 minutes upto 30 minutes, then at 15 minutes interval till the end of surgery and continued for 30 minutes postoperatively. Arterial samples were collected before induction and in group I 30 minutes after desufflation and in group II 60 minutes after desufflation. Result: On comparison between two groups arterial blood gas analysis showed elevation in PaCO2 and reduction in pH more in group 1 (30 min after desufflation) than group 2 (60 min after desufflation). On intragroup comparison there were statistically highly significant increase in PaCO2 (42.99±0.78 Vs 38.03±0.96 in group 1, 42.61±1.06 Vs 39.14±1.05 in group 2) after desufflation as compared to preinsufflation values (p value < 0.000). There were statistically highly significant decrease in pH (7.40±0.02 Vs 7.42±0.02 in group 1, 7.41±0.01 Vs 7.42±0.01 in group 2) and bicarbonate (23.73±1.04 Vs 24.66±0.88 in group 1, 23.74±1.02 Vs 24.65±0.87 in group 2) after desufflation as compared to preinsufflation values (p value < 0.000). Heart rate, systolic, diastolic, mean arterial pressure and EtCO2 were statistically highly significant increase after insufflation and just after desufflation as compared to preinsufflation (p value < 0.000) in both groups (p value < 0.000). Conclusion: Pneumoperitoneum with CO2 insufflation caused significant increased in PaCO2, significant reduction in pH and bicarbonate in the postdesufflation period as compared to preinsufflation in both groups. There were also significant increase in heart rate ,systoloic, diastolic, mean arterial pressure and EtCO2 after CO2 insufflations and postdesufflation as compared to preinsufflation in both groups. There were statistically nonsignificant increase in PaCO2 and decrease in pH more in group 1 than group 2.