Djelovanje upuhivanja ugljičnog dioksida u trbušnu šupljinu kod laparoskopskih kolecistektomija na arterijski tlak u pretilih i nepretilih bolesnika

The effect of carbon dioxide induced pneumoperitoneum and anti-Trendelenburg.s position on arterial pressure was retrospectively analyzed in 34 patients with cholelithiasis and overweight and 34 patients with cholelithiasis and normal body weight. According to general condition, all patients belonged to ASA II and ASA III groups. Upon induction in general endotracheal balanced anesthesia, patients received intermittent positive pressure ventilation. At the time of arterial pressure measurement, the following parameters were determined: respiratory volume 12 mL kg-1 body weight, respiration rate 12 breaths per minute, and inhalation to exhalation time ratio I:E=1:2. Arterial pressure was measured by automated noninvasive method in horizontal position before induction in general anesthesia (T1), upon induction in general anesthesia (T2), upon carbon dioxide inflation into abdominal cavity and anti­Trendelenburg.s position at 25° (T3), upon carbon dioxide deflation from abdominal cavity (T4), and upon completion of the operation and patient extubation (T5). Arterial pressure showed a statistically significant increase after carbon dioxide inflation and a statistically significant decrease upon carbon dioxide deflation (p<0.002 both) in both study groups. In overweight patients, both systolic and diastolic pressure increased with carbon dioxide induced pneumoperitoneum to a mean value of 167±18 mm Hg and 102±10 mm Hg, respectively, as measured at T3. In the group of patients with normal body weight, the respective pressure values were 156±19 mm Hg and 98±9 mm Hg at the same time point.Retrospektivno je analizirano djelovanje pneumoperitoneuma izazvanog ugljičnim dioksidom i anti-Trendelenburgova položaja na arterijski tlak u 34 bolesnika s kolelitijazom i prekomjernom tjelesnom težinom i 34 bolesnika s kolelitijazom i normalnom tjelesnom težinom. Svi su bolesnici prema općem stanju pripadali skupinama ASA II. i ASA III. Nakon uvoda u opću endotrahealnu balansiranu anesteziju bolesnici su umjetno ventilirani intermitentnim pozitivnim tlakom (IPPV). U vrijeme mjerenja arterijskog tlaka zabilježeni su slijedeći parametri: respiracijski volumen 12 mL kg-1 tjelesne težine, frekvencija disanja 12 udisaja u minuti, odnos udisajnog i izdisajnog vremena I:E=1:2. Arterijski tlak mjeren je automatski neinvazivno u vodoravnom položaju prije indukcije u opću anesteziju (T1), nakon uvoda u opću anesteziju (T2), nakon upuhivanja ugljičnog dioksida u trbušnu šupljinu i anti-Trendelenburgova položaja od 25o (T3), nakon ispuhivanja ugljičnog dioksida iz trbušne šupljine (T4) i nakon završetka operacije i ekstubacije bolesnika (T5). Arterijski tlak nakon upuhivanja ugljičnog dioksida u trbušnu šupljinu pokazao je statistički značajan porast (p<0,002) u obje analizirane skupine. Nakon ispuhivanja ugljičnog dioksida iz trbušne šupljine u obje analizirane skupine arterijski tlak je pokazao statistički značajan pad (p