Journal of Clinical and Experimental Investigations

Abstract

Objective: The effects of 10cmH₂O Positive End-expiratory Pressure (PEEP) on respiratory mechanics, arterial oxygenation and hemodynamics in laparoscopic cholecystectomy operation were investigated.
Methods: The study was planned on ASA I-II, 18-65 years old, forty patients scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were divided into two groups which PEEP implemented Group 0 and 10 cmH₂O PEEP applied Group P (Group 0, n=20; Group P, n=20). Heart rate, Mean arterial blood pressure, arterial oxygen saturation (SpO₂), partial pressure of end-tidal carbon dioxide (PEtCO₂), Peak inspiratory pressure (PİP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂ ) values were evaluated at 5 minutes after induction, 5 minutes after CO₂ insufflation, after the head-up position and the right side in the 10^th and 30^th minutes, After 10 minutes desufflation and in the recovery room. The Alveolar–arterial oxygen pressure gradient (P(A-a) O₂), the ratio of physiologic dead space over tidal volume (VD/VT), Arterial to End Tidal CO₂ gradient (P(a-et) CO₂), static compliance (CS), dynamic compliance (CD) were assessed same times.
Results: The assessment between the groups, there were not statistical differences about mean blood pressure, heart rate, SpO₂, PetCO₂, PaO₂, plateau pressure, and P (A-a) values (p>0.05). Peak inspiratory pressure was higher in Group P (p<0.05). Peak inspiratory pressure and plateau pressure increased with CO₂ insufflation in both groups. PaCO₂ and P(a-et) CO₂ were higher statistically significantly in Group 0 (p<0.05). There was no difference between the groups in terms of the PetCO₂ values. VD/VT ratios were statistically significantly lower in the Group P (p<0.05). There was no difference at static compliance values between the groups, dynamic compliance was lower in Group P. According to the initial values, there was a decrease in compliance in both groups after CO₂ insufflation.
Conclusion: 10 cmH₂O PEEP was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in laparoscopic cholecystectomy operation.