Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.028
Brazilian Journal of Anesthesiology
Original Investigation

Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial

Resultado hemodinâmico de diferentes modos de ventilação em cirurgia laparoscópica com Trendelenburg exagerado: um ensaio clínico randomizado

Hakan Yılmaz; Baturay Kansu Kazbek; Ülkü Ceren Köksoy; Ahmet Murat Gül; Perihan Ekmekçi; Gamze Sinem Çağlar; Filiz Tüzüner

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Abstract

Purpose: To compare hemodynamic effects of two different modes of ventilation (volume-controlled and pressure-controlled volume guaranteed) in patients undergoing laparoscopic gynecology surgeries with exaggerated Trendelenburg position.

Methods: Thirty patients undergoing laparoscopic gynecology operations were ventilated using either volume-controlled (Group VC) or pressure-controlled volume guaranteed mode (Group PCVG) (n = 15 for both groups). Hemodynamic variables were measured using Pressure Recording Analytical Method by radial artery cannulation in addition to peak and mean airway pressures and expired tidal volume.

Results: The only remarkable finding was a more stable cardiac index in Group PCVG, where other hemodynamic parameters were similar. Expired tidal volume increased in Group VC while peak airway pressure was lower in Group PCVG.

Conclusion: PCV-VG causes less hemodynamic perturbations as measured by Pressure Recording Analytical Method (PRAM) and allows better intraoperative hemodynamic control in exaggerated Trendelenburg position in laparoscopic surgery.

Keywords

Laparoscopic surgery, Mechanical ventilation, Hemodynamic monitoring

Resumo

Objetivo: Comparar os efeitos hemodinâmicos de dois modos diferentes de ventilação (volume controlado e volume controlado por pressão garantido) em pacientes submetidas a cirurgias ginecológicas laparoscópicas com posição de Trendelenburg exagerada.

Métodos: Trinta pacientes submetidos a operações de ginecologia laparoscópica foram ventilados usando o modo de volume controlado por volume (Grupo CV) ou o modo de volume garantido por pressão controlada (Grupo VGPC) (n = 15 para ambos os grupos). As variáveis hemodinâmicas foram medidas usando o Método Analítico de Registro de Pressão por canulação da artéria radial, além das pressões máximas e médias das vias aéreas e volume corrente expirado.

Resultados: O único achado notável foi um índice cardíaco mais estável no Grupo VGPC, onde outros parâmetros hemodinâmicos foram semelhantes. O volume corrente expirado aumentou no Grupo CV, enquanto o pico de pressão nas vias aéreas foi menor no Grupo VGPC.

Conclusão: o VGPC causa menos perturbações hemodinâmicas medidas pelo Método Analítico de Registro de Pressão (MARP) e permite melhor controle hemodinâmico intraoperatório na posição de Trendelenburg exagerada em cirurgia laparoscópica.

Palavras-chave

Cirurgia laparoscópica, Ventilação mecânica, Monitoramento hemodinâmico

References

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Submitted date:
12/09/2019

Accepted date:
04/25/2021

60b0f005a95395562a122f93 rba Articles

Braz J Anesthesiol

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