EFFECT OF PNEUMOPERITONIUM WITH CARBON DIOXIDE IN ABDOMINAL LAPAROSCOPIC SURGERIES ON HEMODYNAMIC AND ARTERIAL BLOOD GAS PARAMETERS.

Introduction:During laparoscopy, pneumoperitoneum is essential to provide a good surgical field, allowing visibility and performance of surgical maneuvers. Carbon dioxide is the most commonly used gas for pneumoperitoneum. AIMS &Objectives : (1). To determine the hemodynamic changes due to Co2 Pneumoperitonium during laparoscopic surgery, (2). Correlation between PaCo2 and EtCo2 (3) Metabolic effects of Co2 pneumoperitonium and (4). To identify high risk groups to laparoscopic surgery due to Co2 Pneumoperitonium. Material & Methods : This observational study was conducted in the Department of Anaesthesiology and Critical Care , SKIMS Srinagar - Kashmir ,which is a tertiary care referral centre over a period of one year, after obtaining approval from institutional ethical committee and consent of the patients . The sample size of 100 patients, above 18 years of age after fullfilling inclusion & exclusion criteria were enrolled for the study . Result :There were female prepondance , with 67 Females & 33 were Male. Majority of the patients were in the age group of 45 ? 59 years, with Mean age of 43.1 years .On comparing theASA Physical status of study patients , majority were in ASA I = 34 patients , followed by ASA II = 32 , ASA III & ASA IV = 17 each . Majority of patients (58%), underwent LAP Cholecystectomy. In our study we found that , there was gradual decrease in PH over time during the procedure. The change in PH was significant (p-value <0.05) with mean PH of 7.41 in preoperative period , which decreased to PH 7.28 at 180 minutes . However there was increase in pH in postoperative period with mean pH 7.32. we also found that PaCO2 increased significantly after Co2 Pneumoperitonium , with mean PaCO2 of 35.0 mmHg in preoperative period and PaCO2 of 47mmHg at 180 minutes. After deflation and extubation PaCO2 decreased in the postop with mean value of 39.4 mmHg .we found significant (p-value= <0.05) increase in PaCO2 during the procedure and it remained on higher side after extubation. There was significant increase in End tidal Co2 ( EtCo2 ) after Co2 insufflation with , mean EtCO2 = 31.0 mmHg before insufflation , which increased to mean value of 39.8 mmHg at 90 min (p-value< 0.05) . There was significant change in Minute ventilation , before Co2 insufflation was 5.028L/min , which increased to a maximum mean value of 8.4L/min at 180min ( P value Significant ) . Mean HCo3 was 24.9mEq/L which decreased to mean value of 21.8 mEq/L at 15min. After 15min there was satatiscally no significant change in bicarbonate levels. There was no significant mean difference between PaCo2 ? EtCo2 over time during the procedure . Compared to baseline H/R (mean HR = 78.5 b/min ) , there was significant increase in H/R after induction of anesthesia and PNP (mean HR=107.8 b/min) which remained significantly raised up to 60min of the procedure . we also found that, there was significant rise in H/R after extubation (mean HR= 92.7 beats/min). The changes in MAP , which corresponds to change in SBP & DBP were studied in relation to baseline value (mean preoperative MAP = 96.9 mmHg), There was significant decrease in MAP ( 90.2 + 6.3 mmHg ) after induction , followed by significant rise in MAP up to first 45 min, thereafter there was no significant change in MAP. Conclusion :In our study, we concluded that laparoscopic surgery with Co2 pneumoperitonium lead to significant acidosis, increase in PaCo2 and decrease in bicarbonate levels, as well as there was a significant change in hemodynamic parameters. These changes were well tolerated by patients by optimizing patients prior to surgery. A correlation was observed between the PaCo2 and EtCo2 throughout the duration of the insufflation making EtCo2 a reliable monitor of Co2 output during laparoscopy. we also noted significant rise in H/R , BP & MAP , but these changes were well tolerated by patients belonging to different ASA categories. In our study high risk patients (ASA II, III, and IV) were optimized before surgery and the changes induced during procedure were well compensated.