STUDY OF THE ASSOCIATION OF BLOOD CARBON DIOXIDE OUTPUT IN LAPAROSCOPIC CHOLECYSTECTOMYIN AT RIMS RAIPUR CHATTISGARH STATE

Dr. Ravi Kumar Goel; Dr. Ballabhdas Kesrimalji Gahlot; Dr Brajendra kumar

Volume : VII, Issue : IV, April - 2018

STUDY OF THE ASSOCIATION OF BLOOD CARBON DIOXIDE OUTPUT IN LAPAROSCOPIC CHOLECYSTECTOMYIN AT RIMS RAIPUR CHATTISGARH STATE

Dr. Ravi Kumar Goel, Dr. Ballabhdas Kesrimalji Gahlot, Dr Brajendra Kumar

Abstract :

We studied patients undergoing elective laparoscopic cholecystectomy. Carbon dioxide output, oxygen uptake, respiratory exchange ratio (RER), expired minute ventilation (VE), deadspace to tidal volume ratio (VD/VT ratio) and arterial to end-tidal carbon dioxide partial pressure difference (PaCO2-PE‘CO2) were determined before induction, and during anaesthesia, pneumoperitoneum and recovery. By controlling ventilatory frequency (f) every 1 min, PaCO2 was adjusted to concentrations before induction. Constant monitoring of end-tidal carbon dioxide partial pressure (PE‘CO2) and intermittent measurement of (PaCO2-PE‘CO2) (15-min intervals) were conducted to predict PaCO2). Carbon dioxide output and oxygen uptake decreased significantly from mean values of 83.5 (SEM 5.2), 101.6 (5.1) to 68.5 (4.2), 81.1 (4.6) ml min-1 m-2 (ATPS, P < 0.05) with sevoflurane anaesthesia, and RER did not change. During carbon dioxide pneumoperitoneum (intra-abdominal pressure 8 mm Hg), carbon dioxide output increased by 49% (102.4 (5.0) ml min-1 m-2) (P < 0.05) while oxygen uptake remained stable and RER increased from 0.84 (0.02) to 1.16 (0.03) (P < 0.05). It was necessary to increase VE during pneumoperitoneum by 1.54 times that during anaesthesia to maintain individual PaCO2 values constant. After removal of carbon dioxide from the abdominal cavity, the regression equation of excess carbon dioxide output/BSA best fitted a two-compartment model. The time constants of the rapid and slow compartments were 8.2 and 990 min, respectively. Excess carbon dioxide output/BSA was still 5.5 ml min-1 m-2, 30 min after pneumoperitoneum.