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Randomized trial of low versus high carbon dioxide insufflation pressures in posterior retroperitoneoscopic adrenalectomy
Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
Royal North Shore Hosp, Dept Anaesthesia, Sydney, NSW, Australia.
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2018 (English)In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 163, no 5, p. 1128-1133Article in journal (Refereed) Published
Abstract [en]

Background: Posterior retroperitoneoscopic adrenalectomy has gained widespread acceptance for the removal of benign adrenal tumors. Higher insufflation pressures using carbon dioxide (CO2) are required, although the ideal starting pressure is unclear. This prospective, randomized, single-blinded, study aims to compare physiologic differences with 2 different CO2 insufflation pressures during posterior retroperitoneoscopic adrenalectomy.

Methods: Participants were randomly assigned to a starting insufflation pressure of 20 mm Hg (low pressure) or 25 mm Hg (high pressure). The primary outcome measure was partial pressure of arterial CO2 at 60 minutes. Secondary outcomes included end-tidal CO2, arterial pH, blood pressure, and peak airway pressure. Breaches of protocol to change insufflation pressure were permitted if required and were recorded.

Results: A prospective randomized trial including 31 patients (low pressure: n = 16; high pressure: n = 15) was undertaken. At 60 minutes, the high pressure group had greater mean partial pressure of arterial CO2 (64 vs 50 mm Hg, P = .003) and end-tidal CO2 (54 vs 45 mm Hg, P = .008) and a lesser pH (7.21 vs 7.29, P = .0005). There were no significant differences in base excess, peak airway pressure, operative time, or duration of hospital stay. Clinically indicated protocol breaches were more common in the low pressure than the high pressure group (8 vs 3, P = .03).

Conclusion: In posterior retroperitoneoscopic adrenalectomy, greater insufflation pressures are associated with greater partial pressure of arterial CO2 and end-tidal CO2 and lesser pH at 60 minutes, be significant. Commencing with lesser CO2 insufflation pressures decreases intraoperative acidosis.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2018. Vol. 163, no 5, p. 1128-1133
National Category
Anesthesiology and Intensive Care
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URN: urn:nbn:se:uu:diva-356461DOI: 10.1016/j.surg.2017.10.073ISI: 000431940600023PubMedID: 29395236OAI: oai:DiVA.org:uu-356461DiVA, id: diva2:1236105
Available from: 2018-07-31 Created: 2018-07-31 Last updated: 2018-07-31Bibliographically approved

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