Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Scientific Article

Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy

Efeitos de diferentes níveis de pressão expiratória final sobre a hemodinâmica, mecânica respiratória e resposta sistêmica ao estresse durante colecistectomia laparoscópica

Oznur Sen; Yasemin Erdogan Doventas

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Abstract Objective: General anesthesia causes reduction of functional residual capacity. And this decrease can lead to atelectasis and intrapulmonary shunting in the lung. In this study we want to evaluate the effects of 5 and 10 cmH2O PEEP levels on gas exchange, hemodynamic, respiratory mechanics and systemic stress response in laparoscopic cholecystectomy. Methods: American Society of Anesthesiologist I-II physical status 43 patients scheduled for laparoscopic cholecystectomy were randomly selected to receive external PEEP of 5 cmH2O (PEEP 5 group) or 10 cmH2O PEEP (PEEP 10 group) during pneumoperitoneum. Basal hemodynamic parameters were recorded, and arterial blood gases (ABG) and blood sampling were done for cortisol, insulin and glucose level estimations to assess the systemic stress response before induction of anesthesia. Thirty minutes after the pneumoperitoneum, the respiratory and hemodynamic parameters were recorded again and ABG and sampling for cortisol, insulin, and glucose levels were repeated. Lastly hemodynamic parameters were recorded; ABG analysis and sampling for stress response levels were taken after 60 minutes from extubation. Results: There were no statistical differences between the two groups about hemodynamic and respiratory parameters except mean airway pressure (P mean). P mean, compliance and PaO2; pH values were higher in 'PEEP 10 group'. Also, PaCO2 values were lower in 'PEEP 10 group'. No differences were observed between insulin and lactic acid levels in the two groups. But postoperative cortisol level was significantly lower in 'PEEP 10 group'. Conclusion: Ventilation with 10 cmH2O PEEP increases compliance and oxygenation, does not cause hemodynamic and respiratory complications and reduces the postoperative stress response.


PEEP, Hemodynamic, Respiratory mechanics and stress response


Resumo Objetivo: A anestesia geral causa a redução da capacidade residual funcional e essa diminuição pode levar à atelectasia pulmonar e ao shunt intrapulmonar. Neste estudo pretendemos avaliar os efeitos de níveis de 5 e 10 cmH2O de pressão expiratória final positiva (PEEP) sobre as trocas gasosas, a hemodinâmica, a mecânica respiratória e a resposta ao estresse sistêmico em colecistectomia laparoscópica. Método: Foram selecionados aleatoriamente 43 pacientes, estado físico ASA I-II, agendados para colecistectomia laparoscópica, para receber PEEP a 5 cmH2O (grupo PEEP-5) ou PEEP de 10 cmH2O (grupo PEEP-10) durante o pneumoperitônio. Os parâmetros hemodinâmicos foram registrados, gasometria arterial e coleta de sangue foram feitas para estimativa dos níveis de cortisol, insulina e glicose para avaliar a resposta ao estresse sistêmico antes da indução anestésica. Trinta minutos após o pneumoperitônio, os parâmetros hemodinâmicos e respiratórios foram registrados novamente e gasometria e amostragem para os níveis de cortisol, insulina e glicose foram repetidos. E os últimos parâmetros hemodinâmicos foram registrados, análise e amostragem de gasometria para os níveis de resposta ao estresse foram feitas após 60 minutos da extubação. Resultados: Não houve diferença estatística entre dois grupos quanto aos parâmetros hemodinâmicos e respiratórios, exceto pressão média das vias aéreas (Pmédia). Os valores de Pmédia, complacência, PaO2 e do pH foram maiores no grupo PEEP-10. Também os valores de PaCO2 foram menores no grupo PEEP-10. Não foram observadas quaisquer diferenças entre os níveis de insulina e de ácido láctico nos dois grupos. Porém, o nível de cortisol no pós-operatório foi significativamente menor no grupo PEEP-10. Conclusão: Ventilação com PEEP de 10 cmH2O aumenta a complacência e a oxigenação, não causa hemodinâmica e complicações respiratórias e reduz a resposta ao estresse no pós-operatório.


PEEP, Hemodinâmica, Mecânica respiratória e resposta ao estresse


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