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Improved ventilation-perfusion matching by abdominal insufflation (pneumoperitoneum) with CO2 but not with air
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 Radiology, Oncology and Radiation Science, Section of Medical Physics.
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2013 (English)In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 79, no 6, 617-625 p.Article in journal (Refereed) Published
Abstract [en]

Background. Pneumoperitoneum (PP) by CO2-insufflation causes atelectasis however with maintained or even improved oxygenation. We studied the effect of abdominal insufflation by carbon dioxide (CO2) and air on gas exchange during PP. Methods. Twenty-seven anesthetized pigs were studied during PP with insufflations to 12 mmHg by either 1/CO2, 2/ air or 3/CO2 during intravenous nitroprusside infusion (SNP) (N.=9 in each group). In 3 pigs in each group, gamma camera technique (SPECT) was used to study ventilation and perfusion distributions, in another 6 pigs an inert-gas technique (MIGET) was used for assessing ventilation-perfusion matching (V-A/Q). Measurements were made during anesthesia before and after 60 minutes of PP. Results. CO2-PP caused a shift of blood flow away from dependent, non-ventilated (atelectatic) to ventilated regions. Air-PP caused smaller, and SNP-PP even less shift of lung blood flow. Shunt decreased luring CO2-PP (6+/-1% compared to baseline 9+/-2%, P<0.05), did not change during Air-PP (10+/-2%) and increased during SNP-PP (16+/-2%, P<0.05). PaO2 increased from baseline 35+/-2 to 41+/-3 kPa during CO2-PP and decreased to 32+/-3 kPa during Air-PP and to 27+/-3 kPa during SNP-PP (P<0.05 for all three comparisons). PaCO2 increased during CO2- and SNP-PP. Conclusion. CO2-PP enhanced the shift of blood flow towards better ventilated areas of the lung compared to Air-PP and SNP blunted the effects seen with CO2-PP. SNP may thus have blunted and CO2 potentiated vasoconstriction, by hypoxic pulmonary vasoconstriction or another mechanism.

Place, publisher, year, edition, pages
2013. Vol. 79, no 6, 617-625 p.
Keyword [en]
Pulmonary gas exchange, Ventilation, Surgical procedures, operative, Laparoscopy, Carbon dioxide, Models, animal
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-206665ISI: 000322424400007OAI: oai:DiVA.org:uu-206665DiVA: diva2:645095
Available from: 2013-09-03 Created: 2013-09-02 Last updated: 2017-12-06Bibliographically approved

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Strang, Christof M.Hedenstierna, Göran

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