Adaptive support ventilation for gynaecological laparoscopic surgery in Trendelenburg position: bringing ICU modes of mechanical ventilation to the operating room

• DOI: 10.1097/eja.0b013e32831aed42
• Publication Date: 2009-02-03T09:38:05Z
• Authors: Julio Lloréns; Mayte Ballester; Gerardo Tusman; Lucrecia Blasco; Javier García-Fer...; Jose Luis Jover; F Javier Belda
• Keywords: Trendelenburg position; Respiratory physiology; Trendelenburg; Peak inspiratory pressure; Respiratory minute volume; Respiratory Rate

Background and objective The aim of the present study was to test efficacy adaptive support ventilation (ASV) automatically adapt ventilatory settings changes in respiratory mechanics that occur during pneumoperitoneum Trendelenburg position gynaecological surgeries. Methods We prospectively studied 22 ASA I women scheduled for laparoscopic surgery position. After intravenous induction general anaesthesia, patients were ventilated with ASV, a closed-loop mode mechanical based on Otis formula, designed patient's system mechanics, while maintaining preset minute ventilation. Respiratory variables, setting parameters analysis blood gases recorded at three time points: 5 min after (baseline), 15 positioning (Pneumo-Trend) withdrawal (final). Results A reduction 44.4% compliance an increase 29.1% airway resistance observed Pneumo-Trend period. Despite these kept constant. ASV adapted by increasing inspiratory pressure 3.2 ± 0.9 cmH2O (+19%), P < 0.01, rate 1.3 0.5 breaths per (+9%) total ratio (Ti/Ttot) 43.3%. At final time, returned towards their baseline values. Adequate gas exchange maintained throughout all periods. PaCO2 increased moderately (+13%) from 4.4 0.6 (baseline) 5.0 kPa (Pneumo-Trend), 0.01; decreased slightly (4.7 0.8 kPa), 0.05. Clinician's intervention needed only one patient who showed moderate hypercapnia (PaCO2 6.9 kPa) pneumoperitoneum. Conclusion In healthy undergoing gynaecologic laparoscopy, keeping constant ventilation, providing adequate obviating clinician's interventions.