Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients

Background: Because of absorbed carbon dioxide (CO2) and elevated intraabdominal pressure (IAP), CO2 pneumoperitoneum (CO2PP) has potentially harmful intraoperative circulatory and ventilatory effects. Although not clinically significant for healthy patients, these effects are assumed to be deleterious for patients with a high risk for anesthesia (American Society of Anesthesiology [ASA] 3 and 4) and significant cardiopulmonary, renal, or hepatic diseases. The authors assessed CO2PP-related adverse effects by comparing ASA 3 and 4 patients who underwent laparoscopic cholecystectomy (LC) with or without CO2PP. Methods: A total of 20 successive ASA 3 and 4 patients who underwent LC were randomized into CO2PP (n = 10) and abdominal wall elevator (Laparolift) (n = 10) groups. The parameters for perioperative hemodynamics, ventilation, perfusion of intraabdominal organs, and blood chemistry were recorded periodically from before the induction of the anesthesia until postoperative day 2 and compared between the groups. Results: Mean age, height, weight, the proportional number of ASA 3 vs ASA 4 patients, the volume of perioperative fluid loading, and the dose of analgesics did not differ significantly between the groups. The length of the operation was 49.9 +/- 10.6 min for the CO2PP group and 50.6 +/- 17.2 min for Laparolift group (nonsignificant difference). The mean central venous pressure (CVP) 30 min after insufflation was higher (12.3 +/- 4.8 vs 7.9 +/- 3.7 mmHg) and the (Gastric Mucosal pH) pHi at the end of the operation was lower (7.29 +/- 0.07 vs 7.35 +/- 0.04) in the CO2PP group than in the Laparolift group (p < 0.05). Later, CVP and pHi did not di. er significantly. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry did not differ significantly. Conclusions: For LC for patients with an ASA 3 and 4 risk for anesthesia, no significant adverse effects could be attributed to CO2 pneumoperitoneum. For high-risk patients, preoperative preparation and active perioperative monitoring are essential for safe anesthesia for LC with or without CO2PP.