Background: Laparoscopic surgery usually requires a pneumoperitoneum by insufflating the abdominal cavity with carbon dioxide (CO2). Increased intraabdominal pressure causes diaphragmatic displacement resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. Application of positive end-expiratory pressure (PEEP) can maintain pulmonary gas exchange. The objective of this study was to investigate the effect of abdominal gas insufflation on arterial oxygenation during mechanical ventilation with and without PEEP in rats. Methods: In experiment 1, two groups of six rats were continuously insufflated with CO2 at 12 mmHg for 180 min. Group 1 was ventilated with 8 cm H2O PEEP and group 2 had 0 cm H2O PEEP. Group 3 served as a control. This group had abdominal wall lifting and was ventilated with 0 cmH2O PEEP. In experiment 2, two groups of six rats had abdominal CO2 insufflation and were ventilated with or without PEEP during 180 min (group 4 and 5). In this experiment, abdomens were desufflated in both groups for 5 min at 60 and 120 min. Blood pressure monitoring and measurement of arterial pO2 was performed by placement of an indwelling carotid artery catheter in both experiments. Results: In both experiments, PaO2 values decreased significantly in insufflation groups that were ventilated with 0 cmH2O PEEP (groups 2 and 5). Insufflation groups ventilated with 8 cmH2O PEEP had PaO2 values comparable to these of control group. There were no significant differences in mean arterial pressure between insufflation groups ventilated with or without PEEP. Conclusion: PEEP preserves arterial oxygenation during prolonged pneumoperitoneum in rats with minimal adverse hemodynamic effects.

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Surgical Endoscopy: surgical and interventional techniques
Department of Surgery

Hazebroek, E. J., Haitsma, J., Lachmann, B., & Bonjer, J. (2002). Mechanical ventilation with positive end-expiratory pressure preserves arterial oxygenation during prolonged pneumoperitoneum. Surgical Endoscopy: surgical and interventional techniques, 16(4), 685–689. doi:10.1007/s00464-001-8174-y