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Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO₂ levels

Marja-Tellervo Mäkinen, MD^*, Pertti O. Heinonen, MD^*, Ulla-Maija Klemola, MD and Arvi Yli-Hankala, MD PhD

^* From the Department of Anaesthesia and Intensive Care Medicine, Meilahti Hospital,
Eye-Ear Hospital,
and Women's Hospital, University of Helsinki, Helsinki, Finland.

Address correspondence to: Marja-Tellervo Mäkinen MD, Department of Anaesthesia and Intensive Care Medicine, University of Helsinki, Meilahti Hospital, Haartmaninkatu 4, P.O. Box 340 FIN-00029 HUCH, Finland. Phone: 358-9-47172458; Fax: 358-9-47174017; E-mail: marja-tellervo.makinen{at}hus.fi

Purpose: Pneumoperitoneum can cause disturbances in acid-base balance and splanchnic perfusion. We studied the effect of ventilation on acid-base balance and gastric mucosal tonometric values in patients undergoing laparoscopic cholecystectomy.

Methods: Twenty-four patients (ASA I-II) were randomly allocated into two groups. In the fixed ventilation group, ventilation was constant allowing free increase in PCO₂, while in the constant CO₂ group end-tidal PCO₂ was fixed with ventilatory adjustment. Intraabdominal pressure was limited to 12 mmHg. Arterial acid-base balance, automated air tonometric variables and gastric mucosal to arterial PCO₂ gap were determined frequently from anesthesia induction until three hours postoperatively.

Results: During pneumoperitoneum, in the fixed ventilation group arterial PCO₂ changed from 5.0 ± 0.2 to 6.6 ± 0.4 kPa and pH from 7.43 ± 0.03 to 7.33 ± 0.04, tonometric PCO₂ from 5.1 ± 0.5 to 6.9 ± 0.4 and pH from 7.44 ± 0.04 to 7.33 ± 0.04. In the constant CO₂ group these variables remained at control levels (P < 0.01 between groups). The PCO₂ gap remained unchanged without any differences between the groups. In the recovery room all measured variables were within normal range in both groups.

Conclusion: Despite inter-group differences in arterial and tonometric PCO₂ and pH values during CO₂ pneumoperitoneum, the patients did not develop splanchnic hypoperfusion detectable by air tonometric method, as indicated by normal PCO₂ gap in both groups throughout the study.

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