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Improved ventilation-perfusion matching with increasing abdominal pressure during CO(2)-pneumoperitoneum in pigs
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 7, 887-896 p.Article in journal (Refereed) Published
Abstract [en]

Background: CO(2)-pneumoperitoneum (PP) is performed at varying abdominal pressures. We studied in an animal preparation the effect of increasing abdominal pressures on gas exchange during PP. Methods: Eighteen anaesthetized pigs were studied. Three abdominal pressures (8, 12 and 16mmHg) were randomly selected in each animal. In six pigs, single-photon emission computed tomography (SPECT) was used for the analysis of V / Q distributions; in another six pigs, multiple inert gas elimination technique (MIGET) was used for assessing V / Q matching. In further six pigs, computed tomography (CT) was performed for the analysis of regional aeration. MIGET, CT and central haemodynamics and pulmonary gas exchange were recorded during anaesthesia and after 60min on each of the three abdominal pressures. SPECT was performed three times, corresponding to each PP level. Results: Atelectasis, as assessed by CT, increased during PP and in proportion to abdominal pressure [from 9 +/- 2% (mean +/- standard deviation) at 8mmHg to 15 +/- 2% at 16mmHg, P <0.05]. SPECT during increasing abdominal CO(2) pressures showed a shift of blood flow towards better ventilated areas. V / Q analysis by MIGET showed no change in shunt during 8 mmHg PP (9 +/- 1.9% compared with baseline 9 +/- 1.2%) but a decrease during 12mmHg PP (7 +/- 0.9%, P <0.05) and 16mmHg PP (5 +/- 1%, P <0.01). PaO(2) increased from 39 +/- 10 to 52 +/- 9 kPa (baseline to 16 mmHg PP, P <0.01). Arterial carbon dioxide (PCO(2)) increased during PP and increased further with increasing abdominal pressures. Conclusion: With increasing abdominal pressure during PP perfusion was redistributed more than ventilation away from dorsal, collapsed lung regions. This resulted in a better V / Q match. A possible mechanism is enhanced hypoxic pulmonary vasoconstriction mediated by increasing PCO(2).

Place, publisher, year, edition, pages
2011. Vol. 55, no 7, 887-896 p.
National Category
Anesthesiology and Intensive Care
URN: urn:nbn:se:uu:diva-156587DOI: 10.1111/j.1399-6576.2011.02464.xISI: 000292649500016OAI: oai:DiVA.org:uu-156587DiVA: diva2:432833
Available from: 2011-08-07 Created: 2011-08-04 Last updated: 2011-08-07Bibliographically approved

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