Comparison of ventilation with and without positive end expiratory pressure during anesthesia for laparoscopic surgeries

Abstract

Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparoscopic cholecystectomy were enrolled. They were randomized into two groups of 30 each. Group P received PEEP of 10 cm during laparoscopy and group C did not receive any PEEP. The vital parameters, arterial blood gases, and airway pressures were compared in both groups. The oxygenation, (PaO2/FiO2 ratio) was significantly higher in PEEP group (446. 4 ± 113.32 mm of Hg) as compared to the control group (404 ± 51.4 mm of Hg) after one hour of laparoscopy (P= 0.0037). The control group had higher arterial carbon dioxide tension (42.84 ± 2.38 mm of Hg) as compared to PEEP group (41.86 ± 2.33 mm of Hg), (P < 0.001). Both the findings suggest better ventilation perfusion matching in PEEP group. There was a no significant variation in mean arterial pressure and heart rate due to PEEP in our patient population. However the peak airway pressures were significantly higher in PEEP group. 10 cm of PEEP helped in better oxygenation with no significant hemodynamic alterations, in otherwise healthy patients undergoing laparoscopic cholecystectomy.